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Review Question - QID 6825

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QID 6825 (Type "6825" in App Search)
A 68-year-old man reports a 4-week history of progressive left-sided lower back and hip pain. The pain is in the posterior buttock region with radiation to the groin and to the left anterior knee region. The pain is aggravated with walking and improves with rest. There is no history of previous trauma. Radiographs are seen in Figures 14a and 14b, and MRI scans are seen in Figures 14c through 14e. What is the most appropriate treatment option at this time?
  • A
  • B
  • C
  • D
  • E

Epidural steroid injection at L4-5

13%

9/69

Outpatient physical therapy for the lower back

28%

19/69

Non-weight-bearing of the left lower extremity

32%

22/69

Home exercise program, analgesics, and limited use of muscle relaxants

26%

18/69

Cortisone injection of the left greater trochanter region

0%

0/69

  • A
  • B
  • C
  • D
  • E

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Although the imaging reveals generalized lumbar spondylosis and stenosis, in particular at L4-5, the MRI scan of the left hip clearly reveals a stress fracture of the femoral neck. Therefore, the treatment of choice is non-weight-bearing of the left lower extremity. During the evaluation of acute back pain, clinicians must include other possibilities within the differential diagnosis that may mimic mechanical axial back pain; thus, potential complications from a missed diagnosis can be avoided.

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