Before reading the objective findings below, make sure you read the subjective history taking in Part 1 here of this differential diagnosis case.
Observation: Slouched posture. Decreased lumbar lordosis.
Gait: Stiff leg, wide-based gait pattern with very little knee flexion and hip extension.
Tenderness: Generalized tenderness in lower lumbar spine and SIJ with no particular one location. This is the same in weight-bearing (standing/sitting) and non weight-bearing (prone).
Palpation: No warmth to and around the lumbar spine and pelvis.
Lumbar ROM: Painful in all directions but only limited by 25%. No particular DP. Symptoms are generalized in lumbar spine. No peripherlization or centralization of symptoms with repeated movement exam in standing or prone.
Hip and knee ROM: Normal and unremarkable in all planes.
MMT: 4/5 hip flexion that causes low back pain. Both knee flexion and knee extension is 4+/5 that also causes low back pain. No myotomal weakness or remarkable findings distally.
– Negative SLR and prone femoral neural tensioning test.
3+ B L4, 3+ B S1.
– Hoffman sign
– Supinator sign
– 2+ B C5-C7
Based on the above information,
What are your top 3 differential diagnoses?
What type of information did you gain from the video above?
What other objective findings would you look for / test?
Would you treat, refer or treat and refer; and why?