BMJ Case Reports 2012; doi:10.1136/bcr-11-2010-3529
  • Reminder of important clinical lesson

Acute lower back pain mapped by dermatomal scarification in urban Malawi

  1. Alistair Tindall
  1. 1Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Woolwich, London, UK
  1. Correspondence to Dr Tammy Lo, tammylotinghin{at}


Lower back pain is a problem that affects many and generates an economic burden on the National Health Service. In modern days, although it is tempting to rely on specialist imaging for the initial investigation of back pain, it is often unnecessary. Comprehensive clinical examination is immediately available and should detect neurological impairments where they exist. A 32-year-old man from Malawi presented to clinic with lower back pain radiating to the right leg. Inspection revealed traditional scarification marks along the classical path of lumbar nerve root, which coincided with his L5 dermatomal pain. The distribution of his ‘Mphini’ along the typical path of lumbar nerve was identical to his myelography. This report strongly illustrates that in the Western medical setting, accurate history and examination would have allowed correct interpretation of these symptoms and correctly indicated the need for myelography.

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