Dear Colleagues, every month, we drop one clinical question to test your MSK brain and keep you sharp + answer of the previous quiz (at the bottom). Please help spread the quiz by forwarding this email to others in your clinic, or printing out the lunchroom pdf linked below.
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๐๏ธ The New Age Nomad
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A 26-year-old vanlifer and kombucha brewer presents with gradually worsening low back pain over two weeks. The pain is constant, worse at night, and aggravated by movement. He recalls grazing his right hip on a fallen branch while foraging for turkey tail mushrooms to brew a โgut-healingโ kombucha for his Crohnโs disease. Since then, heโs experienced intermittent fevers, chills, and increasing fatigue. On examination, he moves cautiously, has marked lumbar tenderness, and cannot tolerate spinal flexion. Straight-leg raise is painful bilaterally, but there are no neurological deficits.
Which of the following best describes this presentation?
A. Radicular syndrome without DP โB. Inflammatory Arthropathy โC. Atypical Mechanical Condition โD. Radicular Syndrome without directional preference
โ Correct Answer: Feel free to reply with your answer so you remember what you chose! Weโll share the correct one next time (and give you the why so you can learn something new).
๐ฃ Share the quiz with your team
Make it a lunchroom challenge. Print our PDF quiz sheet and pin it up. Debate your answers. Brag when you get it right.
A 32-year-old ex-military survivalist who lives in a shipping container on the outskirts of Palmerston North, reports pain to the right lumbo-sacral region which is worse when running while hunting and crouching to skin game. The pain is with him most of the time, worse at night, and associated with 45โ60 minutes of morning stiffness. He describes frustration because he also has both Achilles tendons causing him issues and an upset gut.
Which of the following best describes this presentation?
A. Articular Dysfunction
B. Inflammatory Arthropathy
C. Atypical Mechanical Condition
D. Radicular Syndrome without directional preferenceโ
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โ Correct Answer: B
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Why?
Possible sacroiliitis with the pain having no clear mechanism, being constant, increasing at night, associated with morning stiffness for up to an hour. Add to this signs of systemic inflammation with achilles tendon pain bilaterally (possible enthesopathy) and irritable bowel. Using the SPADE tool this patient has some signs of spondyloarthropathy, but more information would help this diagnosis, such as family history of inflammatory conditions, bloods tests, response to NSAIDS and imaging.
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See you in a few weeks ๐
Ngฤ mihi, The McKenzie Institute New Zealand Team โWebsite | Socials
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