Differential Diagnosis for Left Lower Back Pain
The patient presents with pain in the left lower back, just above the buttocks, which worsens throughout the day, especially when bending over during yard work. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- Musculoskeletal Strain: This is the most likely diagnosis given the location of the pain and the exacerbation with physical activity such as bending over during yard work. Musculoskeletal strains are common and can occur from overuse or improper lifting techniques.
- Other Likely Diagnoses
- Lumbar Disc Herniation: The pain's location and worsening with bending suggest a possible lumbar disc herniation, which could irritate nearby nerves and cause pain.
- Degenerative Disc Disease: Wear and tear on the spinal discs can lead to pain, especially with activities that increase spinal stress, like bending.
- Sacroiliitis: Inflammation of the sacroiliac joint, which is located at the base of the spine and could be irritated by bending, leading to pain in the lower back.
- Do Not Miss Diagnoses
- Kidney Stone: Although less likely, a kidney stone could cause severe back pain, typically on one side, and could be exacerbated by movement. Missing this diagnosis could lead to severe complications.
- Abdominal Aortic Aneurysm: This is a life-threatening condition that could present with back pain, especially if the aneurysm is leaking. It's crucial to consider this in the differential diagnosis, especially in older patients or those with risk factors.
- Spinal Infection or Abscess: Infections like osteomyelitis or an epidural abscess can cause back pain and are medical emergencies.
- Rare Diagnoses
- Osteoporotic Compression Fracture: Although more common in older individuals with osteoporosis, a compression fracture could cause sudden onset back pain, especially if it occurs in the lumbar spine.
- Tumor: Both primary and metastatic tumors can cause back pain, often constant and progressive, and would be a rare but important consideration in the differential diagnosis.
Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough evaluation to determine the underlying cause of the patient's symptoms.