Based on the exam findings described, the best primary working diagnosis is which?

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Lumbar radiculopathy is the best working diagnosis when exam findings point to nerve root irritation or compression rather than isolated back muscle or joint problems. The key clue is leg-dominant pain that travels in a dermatomal pattern, often with sensory changes in a specific nerve distribution, and may include weakness in a corresponding myotome or reflex changes. This combination signals involvement of a lumbar nerve root rather than only axial back structures.

Facet syndrome would typically present as localized low back pain, worse with extension or facet-loading movements, but without the clear dermatomal radiation or neurologic deficits. Myalgia would show pain in the muscles without associated neurologic signs like sensory loss, weakness in a given myotome, or reduced reflexes. Lumbar disc herniation can cause radicular symptoms too, but when the exam specifically demonstrates nerve-root–level signs consistent with radiculopathy, labeling the condition as radiculopathy captures the neural involvement more precisely than naming a single anatomic cause.