Author: Nick Tilbury / Editor: Fiona Mendes / Codes: MuC1, MuC5, PC1, SLO1, SLO4, TP2Published: 22/03/2023

A 56-year-old plumber presents to the Emergency Department (ED) with a 24-hour history of worsening lower back pain after lifting some heavy bags of cement. He felt something “pop” in his back and had to come home from work due to pain; he has been resting on the sofa ever since. He is concerned because he was incontinent of urine while watching TV and didn’t notice, and now says the area around his groin “doesn’t feel right.”

He is normally fit and well apart from the occasional bout of lower back pain which usually resolves with ibuprofen and rest. He doesn’t take any regular medication and has no relevant family history. He smokes 10 cigarettes a day and drinks 4 pints of lager on Fridays and Saturdays. In addition to the pain, his main concern is how quickly he will be able to get back to work because he is self-employed and has a big job on at the moment.

On examination you note reduced sensation over his posterior iliac crests. There is mild pain on palpation of the lumbar spine. Power is 2/5 in both legs and a rectal examination reveals reduced perianal sensation but anal tone appears normal.

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