Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, localized left-sided lumbar pain, exacerbated by spinal extension and rotation. Pain is described as dull and aching, with no radicular symptoms or neurological deficits. Symptoms are relieved by rest and aggravated by prolonged standing or activity.
Clinical Examination Findings
Examination reveals localized tenderness over the left lumbar facet joints (paraspinal). Range of motion is restricted in extension and left lateral rotation, eliciting concordant pain. Kemp’s test is positive on the left. Neurological exam: motor strength 5/5, sensation intact, deep tendon reflexes symmetric, and straight leg raise negative.
Treatment Protocol
Plan includes a trial of NSAIDs, physical therapy focusing on core stabilization and lumbar mobilization, and activity modification. If refractory, consider diagnostic medial branch block or radiofrequency ablation of the left lumbar facet joints.