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A patient being treated for low back pain with bilateral radiating thigh pain has been seen in physical therapy for six weeks. The patient notes a lack of improvement and feels their symptoms may be worsening. Which of the following new symptom complaints would be the MOST concerning?

1. Sensory disturbance along the posterior thighs
2. Pain radiating to the thoracic spine
3. Inability to fully empty the bladder
4. Weight gain of 5% of body weight

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient being treated for low back pain with bilateral radiating thigh pain has been seen in physical therapy for six weeks. The patient notes a lack of improvement and feels their symptoms may be worsening. Which of the following new symptom complaints would be the MOST concerning?

1. Sensory disturbance along the posterior thighs
2. Pain radiating to the thoracic spine
3. Inability to fully empty the bladder
4. Weight gain of 5% of body weight

As part of the examination for back pain, physical therapists should be screening the patient for serious spine conditions by identifying red flags. 

Red flags are signs and symptoms that may indicate a serious spine condition is present. Red flags should be used in combination with one another to determine the likelihood of a serious spine condition since no singular red flag is indicative of serious pathology.

Let’s explore each of the options:

Option 1 - Sensory disturbance along the posterior thighs
A sensory disturbance along the posterior thighs could be a symptom associated with low back pain. While it would be important to monitor this symptom, it alone would not result in an acute concern or the need for emergency referral. 

A new complaint of a sensory disturbance in the “saddle region” would be a more concerning symptom since it is commonly associated with cauda equina syndrome, which is a serious spine condition that may require emergent referral.

Option 2 - Pain radiating to the thoracic spine
Pain radiating to the thoracic spine is a symptom that may be reported as a patient’s general low back pain worsens. Though this could be seen as a worsening of the patient’s condition, it would not necessarily require emergent action by the therapist.

Option 3 - Inability to fully empty the bladder
An inability to fully empty the bladder (i.e., urinary retention) is a symptom commonly associated with cauda equina syndrome. Other red flags for cauda equina syndrome include new saddle anesthesia, new bowel/bladder disturbance, new motor weakness, unilateral leg pain progressing to bilateral, and alternating leg pain. Though cauda equina syndrome is not fatal, it can signal a surgical emergency since delayed intervention may limit long-term outcomes.

Option 4 - Weight gain of 5% of body weight
Weight gain is not a symptom that is normally associated with serious spine conditions. However, unexplained weight loss should be considered as it can signify the presence of spinal malignancy or a spinal infection. This symptom is considered to be a red flag if the patient has more than 5% weight loss over a six-month period that is unexplained.

The correct answer is Option 3

Let’s explore the all student data:
15% of students selected Option 1, Sensory disturbance along the posterior thighs
10% of students selected Option 2, Pain radiating to the thoracic spine
60% of students selected Option 3, Inability to fully empty the bladder, the correct response
15% of students selected Option 4, Weight gain of 5% of body weight

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out pages 304 and 374 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!