Differential Diagnoses for Lower Back Pain
The patient presents with lower back pain after lifting a heavy box, which is a common scenario for several potential diagnoses. The use of Advil for pain management and limited range of motion, along with exacerbation of pain upon sitting up and walking, guide the differential diagnoses.
Single Most Likely Diagnosis
- Musculoskeletal Strain: This is the most likely diagnosis given the history of lifting a heavy box, which can cause strain to the muscles and ligaments in the lower back. The symptoms of pain, limited range of motion, and exacerbation with movement are consistent with this diagnosis.
Other Likely Diagnoses
- Herniated Disc: The patient's symptoms could also be consistent with a herniated disc, especially if the pain radiates down the leg or if there are symptoms of nerve compression such as numbness, tingling, or weakness.
- Degenerative Disc Disease: Given the patient's age is not specified, but assuming an adult, degenerative disc disease could be a consideration, especially if there's a history of chronic back pain or if the pain is persistent and not relieved by rest.
- Spondylosis or Spondylolisthesis: These conditions involve defects in the vertebrae or the slipping of one vertebra over another, which could be exacerbated by lifting and cause lower back pain.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less likely, this is a medical emergency that requires immediate attention. Symptoms include severe low back pain, bowel or bladder dysfunction, and numbness or weakness in the legs. It's crucial to ask about these symptoms to rule out this condition.
- Spinal Fracture: Especially in patients with osteoporosis or those who have experienced significant trauma, a spinal fracture could be a possibility. This would be more likely if the patient had a fall or experienced severe pain immediately after lifting.
- Infection (Discitis or Osteomyelitis): Infections of the spine are rare but serious conditions that could present with back pain, fever, and possibly neurological deficits. A history of recent infection or immunocompromised state would increase suspicion.
Rare Diagnoses
- Spinal Tumor: Tumors of the spine, whether primary or metastatic, can cause back pain, neurological symptoms, and systemic symptoms like weight loss. This would be a consideration in patients with a known history of cancer or unexplained weight loss.
- Ankylosing Spondylitis: A chronic inflammatory disease that can cause back pain and stiffness, particularly in younger patients. It might be considered if there's a history of chronic back pain, morning stiffness, or if other symptoms like uveitis or peripheral arthritis are present.