History - Back pain and sciatica

From CambridgeNotes

History of Presenting Complaint

  • Timing: onset (acute – trauma, bending, twisting?); diurnal variation (worse in mornings suggests inflammatory conditions while worse in evenings suggests degenerative disease)
  • Location: true sciatica radiates beyond knee
  • Quality and severity: sleep disturbed and unremitting pain suggests tumour or tuberculosis
  • Exacerbating factors such as movement (mechanical), immobility (inflammation); relieving factors such as rest, activity, squatting (spinal claudication)
  • Red flags: urinary retention or incontinence, faecal incontinence, saddle anaesthesia, weakness in lower extremities; unexplained weight loss, fever or chills

Past Medical History

Drug and Allergy

Family History

  • Ankylosing spondylitis

Personal and Social History

  • Work – heavy lifting
  • IV drug use (infection?)

Systems Review

  • Abdominal and psychiatric

Differential Diagnosis

  • Sinister: tumour, infection, cauda equina, fracture
  • Sciatic: prolapsed intervertebral disc
  • Mechanical: muscle sprain, poor posture, spondylosis
  • Inflammatory: RA, ankylosing spondylitis, secondary to osteoarthritis
  • Referred: AAA, pancreatitis
  • Psychogenic: depression
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