title: Differential diagnosis of a patient with low back and toe pain.
abstract: Low back pain is one of the most commonly 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 many reasons why appropriate medical screening and referral is important in the physical therapy setting. The purpose of this case report is 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 indicated 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. Even with physician referral, it is imperative for clinicians to be proficient in screening for non-mechanical low back pain that may mimic a musculoskeletal origin of symptoms.
authors.affiliation: University of Wisconsin Hospital and Clinics/Meriter Hospital, Madison, WI, USA.
authors.forename: Elizabeth Cooper
authors.initials: EC
authors.lastname: Wahl
authors.affiliation: Department of Pediatric and Orthopedics/Rehabilitation, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Sesto
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: William
authors.initials: W
authors.lastname: Boissonnault
keywords: Medical screening; Non-mechanical back pain; Physical therapy; Psoriatic arthritis; Spondyloarthropathy