05-24-2007, 08:34 PM
A 72-year-old white male is being evaluated for mild back pain and bilateral leg pain which is worse in the right leg. The leg pain, which is mainly in the calf, is precipitated by walking one block. While walking, he also notes a weak feeling in his legs and a slight worsening of his back pain. He has no nighttime leg pain. Physical examination shows mild tightness of his lower lumbar musculature, with normal strength, sensation, and reflexes in his legs. A straight leg raising test is negative bilaterally. His femoral pulses are normal, with a slight decrease in his pedal pulses. Lumbar spine films show changes of degenerative disk disease and arterial Doppler studies of his lower extremities suggest minimal stenosis of the right superficial femoral artery.
Which one of the following would be the most appropriate next step?
a)Evaluation by a physical therapist for strengthening of the legs and ultrasound treatments of the lower back
b)Treatment with a nonsteroidal anti-inflammatory drug
c)A CT or MRI scan of the lumbar spine
d)A series of three epidural steroid injections
e)Angiography of the right leg
Which one of the following would be the most appropriate next step?
a)Evaluation by a physical therapist for strengthening of the legs and ultrasound treatments of the lower back
b)Treatment with a nonsteroidal anti-inflammatory drug
c)A CT or MRI scan of the lumbar spine
d)A series of three epidural steroid injections
e)Angiography of the right leg