Spinal fractures Quiz: Ace Your Exams

A 77-year-old man presents to the emergency department after a fall. The patient was walking his dog when he tripped and fell directly on his back. He did not hit his head. The patient has a past medical history of hypertension, atrial fibrillation, and multiple myeloma. He takes amlodipine and rivaroxaban daily. Temperature is 37°C (98.6°F), blood pressure is 92/64 mmHg, heart rate is 52 beats per minute, respiratory rate is 20 breaths per minute, and oxygen saturation is 99% on room air. On primary survey, the patient appears uncomfortable and has severe lower back pain. Bilateral breath sounds are present, and there is no evidence of obvious bleeding. The patient can move both lower extremities; however, he cannot lift his legs off the bed. Sensation in the perinium is diminished. The secondary survey reveals point tenderness at the L4-L5 level. Which of the following additional physical examination findings would be expected given the most likely diagnosis?