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  #1  
Old 07-23-2011
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Rheumatology/Orthopedics Back Pain that worsens with rest!

A 58-yr-old female presents to your clinic for follow up of backache which has not subsided with NSAID. Past h/o is significant for breast cancer and wt loss. Pain worsen by rest and does not improve much. Neurological examination, straight leg rising test are normal. There is no restriction of movement. Which of these is most likely diagnosis?
1. Spinal stenosis
2. Disc herniation
3. Lumbosacral strain
4. Malignency related metastasis
5. Spondylolysis
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  #2  
Old 07-23-2011
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D due to metastasis
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Old 07-23-2011
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D due to malignancy
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Old 07-23-2011
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Default A Spinal stenosis

A Spinal stenosis
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Old 07-23-2011
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D Malignancy related metastasis
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Old 07-23-2011
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4. Malignency related metastasis ( causing compression of the cord)
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Old 07-24-2011
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DDDDDDDDDDDDDDDDDDd
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Old 07-24-2011
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4. Malignency related metastasis
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Old 07-24-2011
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4. Malignency related metastasis
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Quote:
Originally Posted by dr-ahmed View Post
A Spinal stenosis
not spinal stenosis because pain decrease by sitting
and this patient pain is constant not relieve by anything with hx of ca and wt lose
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  #11  
Old 07-24-2011
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In a 58 yr old woman with a Hx of breast cancer, the answer has to be metastatic malingnancy...
but 'the pain that worsens with rest'...isn't it the feature of spondylosis..?? also they didnt mention anything abt tenderness
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Old 07-24-2011
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D Malignency related mets
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Old 07-24-2011
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Post 4

the answer is no.4 due to metastasis to the lumber spine.....
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Old 07-24-2011
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Default correct answer?

What's the correct answer Confident?
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  #15  
Old 07-24-2011
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Answer is 4. Malignancy related metastasis...pain worsen by rest and h/o malignancy and wt loss indicate 4. as answer.

Straight leg rise test normal mostly rules out Disc herniation.

Spinal stenosis: stooped posture, pain relief on rest i,e sitting and bending, usually chronic 2-3yrs ....

Spondylolysis mostly asymptomatic . Occurs when there is great stress like in sports, gymnastics etc. It may also be congenital due to defective ossification. Mostly cause damage to pars part of vertebrae.

Most of disease pain relief on rest and with NSAID.

But in malignancy pain occurs at night, at rest, and does not relief with NSAID.
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