Mechanical back pain Quiz: Ace Your Exams
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A 55-year-old woman presents to the primary care clinic with one week of low back pain. She describes the pain as a sharp, constant ache localized to her lower back that worsens with movement, especially when bending forward or twisting. There has not been recent trauma or overexertion, but she had significant coughing last week with a viral illness. The patient's medical history is significant for systemic lupus erythematosus (SLE), for which she has been on steroids continuously for the last six months. She denies radiating pain to the legs, numbness, tingling, bowel or bladder incontinence, and fever. Vitals are within normal limits. The patient appears uncomfortable when lying flat. There is significant tenderness to palpation over the lumbar spine at L3 and L4 vertebrae, but no deformities or visible swelling is present. Paraspinal muscles are nontender. Neurological examination reveals 5/5 strength, normal sensation, and 2/4 reflexes in the lower extremities. Straight leg raise test is negative. Which of the following is the most probable cause of this patient’s symptoms?
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