In the ED, their vitals/exam are as above. Likely recurrence of patient’s mild chronic back pain exacerbated by lumbar strain. Lower suspicion for fracture considering lack of focal midline TTP, cord compression considering lack of weakness/foot drop, cauda equina considering lack of bilateral radiculopathy/bowel or bladder incontinence/saddle sensory loss, epidural abscess considering lack of fever/IVDU/point TTP, pyelonephritis as patient without fever/urinary sxs, PE as patient is without tachycardia/hypoxia/respiratory distress, or aortic dissection as patient without chest pain/significant vital sign instability/abnormal distal pulses.
– Labs/Tests: None
– Imaging: ***
– Treatments: Motrin, Tylenol, Lidocaine patch. Low threshold for valium if patient with spasm and has safe ride home. Low threshold for trigger point injection (prep area with chlorhexadine, immobilize area of spasm with left hand, insert 25G needle at 30 degree angle, redirect needle in North/South/East/West directions [to ensure all areas of spasm were inactivated], inject 1-2cc lidocaine 1% at center of spasm, massage the area).
– Consults: None
– Dispo: Likely discharge