34-year-old male presents to the office with the complaint of lower back pain...

in #medical • 7 years ago (edited)

A 34-year-old male presents to the office with the complaint of lower back pain. History reveals that he recently began training for his first 5K race. The pain has been present for approximately two weeks, is described as occasional, position-dependent, sharp pain in the right lower back without radiation down either leg. Physical examination reveals a negative straight leg raise test, full strength, sensation, and 2/4 reflexes. Osteopathic examination reveals a standing flexion test is positive on the right, a superior ASIS on the left and a superior PSIS on the right. The most likely diagnosis is?

  1. anterior innominate rotation on the left
  2. anterior innominate rotation on the right
  3. inferior innominate shear on the left
  4. posterior innominate rotation on the left
  5. superior innominate shear on the right
#comlex #omm
7 years ago in #medical by
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     7 years ago 

    anterior innominate rotation on the right

    This patient has a typical history and physical examination consistent with Mechanical Low Back Pain.

    The osteopathic examination reveals the diagnosis of an anterior innominate rotation on the right.

    • The first step in making this diagnosis is determining the side of the dysfunction. The patient's history points toward a right sided dysfunction, however the discomfort does not always correlate with the side of dysfunction. It is important to not just chase pain complaints, but to thoroughly evaluate the musculoskeletal system for somatic dysfunction.

    The side of dysfunction in innominate dysfunctions can be determined using the standing flexion test.

    • This is done by putting your thumbs on the underside of the PSIS and having the patient bend forward at the waist.
      • If asymmetry in motion is detected, the side with the PSIS that moves more cephalad is considered the positive side, and is the side of the somatic dysfunction.
      • The practitioner must then evaluate for symmetry or asymmetry between the bilateral ASISs and PSISs and assess for leg length discrepancies.
      • In an anteriorly rotated innominate, the ipsilateral ASIS will be inferior while the ipsilateral PSIS will be superior.
      • There will also be an apparent long leg ipsilaterally.
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