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March 10, 1999

Clinical Crossroads: A 45-Year-Old Man With Low Back Pain

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor


Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;281(10):893-895. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-10-jac90000

To the Editor: With regard to Dr Weinstein's discussion,1 what was the official diagnosis for Mr S? Based on his history and physical examination, this patient most likely developed a disk herniation and subsequent L5 and/or S1 radiculopathy(ies), with or without concomitant spinal stenosis. Was weakness present and the cause of the patient's limp? No mention is made of testing for a Trendelenburg sign (patient stands or hops on 1 limb, while elevating the other; weak hip abductors will cause a tilt of the pelvis away from the affected side during stance), leg length discrepancy, or hip range of motion abnormalities. The presence of any of these features in an athlete should be addressed, and the athlete should not continue running with a limp until appropriately diagnosed and treated. Weinstein states that this patient does not have any evidence of ongoing denervation; however, this can occur in relation to radiculopathies, even in cases in which pain is not reported or weakness is not detected on examination. Physical examination and electrodiagnostic studies will be the only methods to detect this uncommon but still possible occurrence, and need to be considered as part of the diagnostic armamentarium, when necessary.

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