iHuman Week 9 Case: 54-Year-Old Male with Back Pain (Robert Miller)
Anatomical overview of the lumbar spine and intervertebral discs.
Patient Profile & History
Demographics & CC History of Present Illness (HPI) Past Medical History (PMH)
, Name: Robert Miller Age: 54 Gender: Patient reports sudden onset of sharp, PMH: Hypertension (controlled).
Male Chief Complaint: Acute low stabbing low back pain after lifting Vitals: BP 138/88, HR 72. BMI: 30
back pain. heavy boxes 2 days ago. Pain radiates (Obese Class I).
down into the left buttock and
posterior thigh.
Physical Examination & Diagnostic Imaging
Physical Exam Findings Imaging Results (MRI Lumbar Spine)
• Straight Leg Raise (SLR): Positive on the left at 45 • Finding: Large posterolateral disc herniation at the L4-
degrees (reproduces radicular pain). • Reflexes: 1+ L5 level. • Impact: Significant compression of the exiting
(decreased) left Achilles reflex; 2+ right Achilles. • Motor: nerve root and narrowing of the left neural foramina.
4/5 strength in left plantar flexion.
Clinical Spotlight: Radiculopathy
Radiculopathy occurs when a nerve root in the spinal column is compressed or inflamed. Clinical
hallmarks include:
• Paresthesia: Numbness or 'pins and needles' in a specific
dermatome.
• Radicular Pain: Sharp, shooting pain radiating along the nerve
path (e.g., Sciatica).
• Hyporeflexia: Diminished deep tendon reflexes (e.g.,
S1/Achilles or L4/Patellar).
• Motor Weakness: Loss of strength in muscles innervated by
the affected root.
Critical Thinking: Clinical Correlation
Based on Robert Miller's physical exam findings (specifically the decreased left Achilles reflex and the
positive SLR), explain how these clinical signs correlate with the MRI finding of an L4-L5 disc herniation.
Anatomical overview of the lumbar spine and intervertebral discs.
Patient Profile & History
Demographics & CC History of Present Illness (HPI) Past Medical History (PMH)
, Name: Robert Miller Age: 54 Gender: Patient reports sudden onset of sharp, PMH: Hypertension (controlled).
Male Chief Complaint: Acute low stabbing low back pain after lifting Vitals: BP 138/88, HR 72. BMI: 30
back pain. heavy boxes 2 days ago. Pain radiates (Obese Class I).
down into the left buttock and
posterior thigh.
Physical Examination & Diagnostic Imaging
Physical Exam Findings Imaging Results (MRI Lumbar Spine)
• Straight Leg Raise (SLR): Positive on the left at 45 • Finding: Large posterolateral disc herniation at the L4-
degrees (reproduces radicular pain). • Reflexes: 1+ L5 level. • Impact: Significant compression of the exiting
(decreased) left Achilles reflex; 2+ right Achilles. • Motor: nerve root and narrowing of the left neural foramina.
4/5 strength in left plantar flexion.
Clinical Spotlight: Radiculopathy
Radiculopathy occurs when a nerve root in the spinal column is compressed or inflamed. Clinical
hallmarks include:
• Paresthesia: Numbness or 'pins and needles' in a specific
dermatome.
• Radicular Pain: Sharp, shooting pain radiating along the nerve
path (e.g., Sciatica).
• Hyporeflexia: Diminished deep tendon reflexes (e.g.,
S1/Achilles or L4/Patellar).
• Motor Weakness: Loss of strength in muscles innervated by
the affected root.
Critical Thinking: Clinical Correlation
Based on Robert Miller's physical exam findings (specifically the decreased left Achilles reflex and the
positive SLR), explain how these clinical signs correlate with the MRI finding of an L4-L5 disc herniation.
