Presenting Complaints

• 24-year-old female patient presents with a chief complaint of low back pain.

History of Presenting Complaint

• The patient reports experiencing a sudden onset of sharp, aching pain in her lower back 3 days ago.
• The pain started after she spent a long day working in the garden, doing heavy lifting and bending.
• The pain is worse with movement, especially bending forward or twisting, and is relieved somewhat by rest.
• She also reports some mild radiating pain down her right leg, but no numbness or tingling.
• She denies any recent trauma or falls.

Significant Positives & Negatives For Differentials

Lumbar Strain/Sprain

Positives:

• Sudden onset of low back pain after physical activity
• Pain worse with movement, especially bending and twisting
• Pain relieved with rest
• No significant neurological symptoms (numbness, weakness, bowel/bladder dysfunction)
• No history of prior back issues

Negatives:

• Presence of radiating leg pain, even if mild
• Lack of significant improvement with conservative management over time

Lumbar Disc Herniation

Positives:

• Radiating leg pain, even if mild
• Lack of significant improvement with conservative management over time

Negatives:

• Absence of more significant neurological symptoms (numbness, weakness, bowel/bladder dysfunction)
• Relatively acute onset rather than gradual progression of symptoms

Sacroiliac Joint Dysfunction

Positives:

• Location of pain in the lower back/sacroiliac region
• Exacerbation of pain with specific provocative maneuvers

Negatives:

• Lack of significant pain with palpation or provocation of the SI joint
• Presence of radiating leg pain, which is less common with isolated SI joint issues

Referred Pain from Abdominal/Pelvic Pathology

Positives:

• Absence of other concerning symptoms (fever, weight loss, etc.)
• Lack of significant improvement with conservative management

Negatives:

• Relatively acute onset of pain rather than a more gradual, insidious presentation
• Absence of other signs/symptoms referable to abdominal or pelvic organs

Past Medical History

• No significant past medical history.
• No prior episodes of back pain.

Drug/Medication History

• Takes no regular medications.
• Occasionally takes ibuprofen for menstrual cramps.

Social History

• Works as an office administrator.
• Lives with her husband in a small apartment in Shanghai.
• Enjoys gardening as a hobby.
• Non-smoker, occasional social drinker.

Family History

• No family history of back problems or musculoskeletal disorders.

Systems Review

• Denies any bowel or bladder dysfunction.
• No fever, chills, or unexplained weight loss.
• No history of cancer, autoimmune disorders, or other chronic medical conditions.

Ideas, Concerns & Expectations

• The patient is concerned that she may have injured her back while gardening and is worried it may be a serious problem.
• She hopes the doctor can provide some treatment to relieve the pain and allow her to return to her normal activities.

Case Presentation

Based on the patient's history and the key positives and negatives for the differential diagnoses, the most likely diagnosis is a lumbar strain or sprain. The acute onset of pain after physical activity, lack of significant neurological symptoms, and improvement with rest are all consistent with a musculoskeletal injury. While the mild radiating leg pain could suggest a disc herniation, the overall presentation is more suggestive of a lumbar strain. A focused physical exam and potentially imaging studies may help confirm the diagnosis and guide management.