Right low back, right lateral thigh, and anterior thigh pain

I was asked to see this patient who appeared on his own in the pain clinic for acute right low back, right lateral thigh, and anterior thigh pain of two days’ duration. He came in with his wife who drove him for physical therapy.

This patient was seen today in clinic at the request of our outside Dr. who was seeing the patient for chiropractic treatment. Dr. felt that the patient appeared acutely ill and worried that he may have had a hernia or some other condition intercurrent with his acute pain and felt uncomfortable treating him with chiropractic for the first time without him being evaluated by me, a medical specialist to assess his overall status. The patient is a 66-year-old male who complains of pain of two days’ duration starting after a day of work. He complains of acute right lower back sacroiliac joint area pain, lateral thigh, and anterior thigh pain without radiation. The patient claims that he is the president of a steel fabricating corporation, was at work and lifted some heavy objects and that evening felt like he had some kind of a strain or pain that has radiated in those stated areas. He was using ice to make the pain better and initially said his pain level was 7 and it had gone down to a 4. The patient claims that he has never had this kind of injury or pain in the past and as mentioned above it is only two-day duration. Of concern is the fact that the patient has intercurrent diabetes and has not been eating for two days because of his pain nor has he taken his diabetic medication or checked his blood sugar. He seems acutely disoriented on presentation and very weak.

DIAGNOSES:
847.2 Acute lower back sprain.
Systemically ill, likely hyperglycemic or hypoglycemic.
Dehydration.
Disorientation.

RECOMMENDATIONS:
Because of his acute state of illness, I recommend he go to the emergency room immediately for evaluation of his electrolytes, his blood sugar for rehydration and possible CT scan if necessary to evaluate his brain. It would be inappropriate at this time to treat him with chiropractic or physical therapy given that he has an overriding condition that is more pressing at this time. I explained everything in detail to him, his wife, and his son. I offered them an ambulance to take them to the emergency room, but they elected to drive to a local emergency room because I felt that he was not having an acute stroke. I thought it was okay to be driven to the emergency room. I also explained to them that they should follow their primary care doctor and tell him what is happening. Additionally, I told him the importance in someone who is a diabetic, to check blood sugar on a regular basis to make sure the medications are working and that in the future after this acute problem resolve if he would like to be treated for his lower back pain and lateral anterior thigh pain that he comes back to our clinic for reevaluation and multitude of treatment modalities that may well benefit him in that regard.

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