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Outpatient = patient that are not warded/admitted

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64-year old retired male - age = degeneration, joint stiffness, sedentary lifestyle, suppressed immunity thus prone to infection, retired = use less muscle might experience muscle stiffness or sprain due to compression of nerve

complaint of lower back pain - muscular skeletal issue, loss of resilience of muscle, strained or trauma, tumour, refered pain (loin pain, kidney problem)

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64-year old retired male - age = degeneration, joint stiffness, sedentary lifestyle, suppressed immunity thus prone to infection, retired = use less muscle might experience muscle stiffness or sprain due to compression of nerve

complaint of lower back pain - muscular skeletal issue, loss of resilience of muscle, strained or trauma, tumour, refered pain (loin pain, kidney problem)

Question associated

muscle sprained

intervertebral disc herniation

degenerative disc disease

osteoporosis - male and age related

vertebral body, nerve compression - due to trauma

rheumatoid arthritis - autoimmune

primary from multiple myeloma thus metastasis - tumour

spinal stenosis - compress nerve due to narrowed spinal canal

scoliosis

abdominal aortic aneurysm

osteoarthritis of vertebra - trauma, injury

Paget's disease - enlarge / misshape of bone affect spine lead to back pain

ankylosing spondylitis

osteomyelitis

infection - TB, epidural abscess

obesity - compression from the extra body weight

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muscle sprained

intervertebral disc herniation

degenerative disc disease

osteoporosis - male and age related

vertebral body, nerve compression - due to trauma

rheumatoid arthritis - autoimmune

primary from multiple myeloma thus metastasis - tumour

spinal stenosis - compress nerve due to narrowed spinal canal

scoliosis

abdominal aortic aneurysm

osteoarthritis of vertebra - trauma, injury

Paget's disease - enlarge / misshape of bone affect spine lead to back pain

ankylosing spondylitis

osteomyelitis

infection - TB, epidural abscess

obesity - compression from the extra body weight

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aching pain in the lower lumbar area for the last few

months, but during the past three weeks, the pain became worse than

usual- chronic pain, may have fracture

The pain was fairly localised without radiation, exacerbated with

exertion. The patient did not experience any tingling, numbness or

weakness- not involve nerve compression (sciatica),intervertebral disc collapse, Sciatica (pain radiates to lower limb), pain worse in do activity

weight gain up to 80 kg (increased 5 kg over one year) and he felt he might be "shrinking” - increasing body weight, decrease body height, certain posture, check BMI

no history of undergoing surgery or having trauma in the past- rule out post-surgical infection, spinal procedure, fall, motor accident

no family history of chronic diseases or malignancies- rule out arterosclerosis, spinal tumour

no history of being treated with systemic glucocorticoids or receiving androgen- deprivation therapy. There were no known allergies revealed- systemic glucocorticoid (steroid) use in autoimmune disease, inhibit osteoblast but increase osteoclast, androgen - deprivation therapy lower testosterone so can reduce bone density cause osteoporosis in vertebrae, transgender also receive androgen - deprivation therapy, help to describe medication

smoker with a 45 pack-year history.The patient had a history of moderate alcohol consumption.-smoke slow healing process, nicotine can affect bone absorption of calcium in bone, can affect osteoclast, alcohol increase risk osteoporosis because it affect bone remodeling

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muscle sprained

intervertebral disc herniation

degenerative disc disease

osteoporosis - male and age related

vertebral body, nerve compression - due to trauma

rheumatoid arthritis - autoimmune

primary from multiple myeloma thus metastasis - tumour

spinal stenosis - compress nerve due to narrowed spinal canal

scoliosis

abdominal aortic aneurysm

osteoarthritis of vertebra - trauma, injury

Paget's disease - enlarge / misshape of bone affect spine lead to back pain

ankylosing spondylitis

osteomyelitis

infection - TB, epidural abscess

obesity - compression from the extra body weight

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Temperature 37.0ºC 36.6 – 37.2ºC= normal

Heart rate 80 beats per minute= normal

60 – 100 beats per minute= normal

Respiratory rate 16 breaths per minute = normal

Blood pressure 120/80 mmHg= normal

patient’s BMI was 24.7 kg/m2= obese

prominent kyphosis of his thoracic spine and the

occiput-wall distance was more than 5 cm.

The rib-pelvis distance was less than two fingerbreadths.

No gait changes were observed.

The patient exhibited localised tenderness to palpation in the lower lumbar area.

The physical examination did not reveal any signs of lumbar

radiculopathy or nerve damage.

Also, the review of records did demonstrate that the patient was approximately 5.5 cm shorter in height than five years ago.

There was no evidence of regional lymphadenopathy.

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kyphosis= abnormality of the spine causing excessive curvature of the upper back ( thats why the patient shrink)

occiput-wall distance = test to measure from the back of the head to the wall ( abnormal ) ( normal 0-2 )

fingerbreadths= two fingers measure , spleenomegaly , hepatomegally no need measuring tape

rib-pelvis distance = measure space from the 11th rib and the ip bone

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Dual X-ray absorptiometry (DXA) = medical imaging test to measure bone mineral density , differentiate between bone and soft tissue

Prostatic Specific Antigen (PSA) = to diagnose prostate cancer , high prostate cancer caused by enlargement of prostate

osteopenia (-1.0 untill -2.5)= low bone mineral density that normal , differentiate between osteoporosis ( T SCORE below than -2.5)

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Dual X-ray absorptiometry (DXA) test results showed low bone density at the femoral neck with a T-score of -1.9 (osteopenia) and a T score of -3.5 (osteoporosis) at L3-L5.

On lateral thoracolumbar spinal radiographs, the radiologist made a note of two vertebrae being wedge-shaped meeting the criteria for vertebral compression fracture = senget , causing kyphosis

Based on history, physical examination, laboratory and imaging studies results, the patient was diagnosed with osteoporosis complicated with a vertebral compression fracture

Therapy with a bisphosphonate (alendronate) was started along with calcium and vitamin D supplementations.= inhibit osteoclast ,

Lumbar support back brace for 12 weeks was given to help alleviate

lower back pain and stabilise the injury and was prescribed non-steroidal anti-inflammatory drugs for the pain.= reduce pain and inflammation

Cessation of alcohol consumption and physiotherapy programme with

manual techniques, clinician-led exercises, and home exercises were recommended= management

follow-up appointment made after three months, serial spinal radiographs showed progressive vertebrae union = vertebrae is uniting back