Differential diagnosis of a patient with low back and toe pain

Low back pain is among the most frequently treated conditions by outpatient orthopedic physical therapists. The management of low back pain is also responsible for a large economic burden in the United States and internationally, which highlights one of the numerous reasons why appropriate medical screening and referral is significant in the physical therapy setting. The purpose of the case report was to describe the successful physical therapist screening and subsequent medical differential diagnosis of a 36- year-old male with chronic lower back and toe pain. Initial physical therapy evaluation supported a diagnosis of mechanical low back pain, but symptom progression through two treatment sessions suggested that a non-mechanical source of pain was instead the likely cause of the patient’s symptoms. The referring physician was contacted by the physical therapist and the patient was scheduled for further medical examination. A consult to rheumatology was placed and through compilation of clinical, laboratory, and imaging findings, a diagnosis of human leukocyte antigen B-27-positive spondyloarthropathy was made.

The report shows that even with physician referral, it is critical for clinicians to be proficient in screening for non-mechanical low back pain that may emulate a musculoskeletal source of symptoms.