1. Stephen Newman, MD Family Practice
Case Review
Stephen Newman, MD
Family Practice

2. June 2016
52 yo Af Am male- presented to ED debilitating left pelvic pain radiating form the hip.
Progressive for 5 months
Insidious onset/no trauma/ no previous LBP
No bowel/bladder dysfunction
Pain increased with walking

3. PMHx
was found to have untreated HTN at the time of his presentation
Social married attorney who enjoys golf
No cig/ETOH abuse
No past surgery/medications/hospitalizations
FH positive for HTN/diabetes/prostate cancer
ROS no constitutional sx

4. Positive exam findings
Hypertension and pain with hip flexion
Pelvic MRI negative
Llumbar MRI diffuse annular buldge L4-5 L5-S1
Small annular tear L4
Question of cyst L4

5. Treatment
Over the next several months symptoms waxed and waned with OMM/NSAIDS/Baclofen/stretching

6. 9 months
Symptoms returned unable to play golf or sit or stand for prolonged periods pain relieved with constantly changing position
Further evaluation for neuropathy LLE confirmed electrophysiological evidence of bilateral S1 and left L5 radiculopathy

7. Repeat MRI cyst again noted L4 nerve root
Likely synovial cyst with severe left neural foraminal narrowin L4-5
Spine consult with Drs. Rumery and Suzman resulted in a left ESI which gave % pain relief for a period of time

8. Currently
Pain waxes and wanes
Influenced by activity
Relief with gabapentin/baclofen
Limited ability to golf and stand for prolonged periods
Considering surgical intervention