Differential diagnosis of spondylolysis in a patient with chronic low back pain jill theinnissenbaum, mpt, scs, atc1 william g. Assessment of back pain differential diagnosis of symptoms. For many individuals, episodes of back pain are selflimited. A thorough examination led to a differential diagnosis of intraarticular. Oct 17, 2012 a 39 year old primigravid woman who was 36 weeks pregnant presented to the maternity unit with a one day history of worsening intermittent abdominal pain and vomiting. The purpose of this poster is to present a case involving a very common diagnosis, low back and flank pain, in an adult with developmental disability whose communication skills. Oct 10, 2011 onset of ripping or tearing back pain, saddle anesthesia, represents an acutely herniated disc, needs an emergent mri for diagnosis, managed emergently in the or epidural abscess iv drug user with fever and back pain, also in diabetics or patients with recent epidural injections, needs an emergent mri for diagnosis. This may indicate the mechanical problem of the neck. Visceral pain is poorly defined and diffuse and commonly described as deep, gnawing, twisting, aching, colicky, or dull 1.
Visceral pain responses are provoked by ischemia, inflammation, and distention. Approximately two thirds of adults are affected by mechanical low back pain at some point in their lives, making it the second most common complaint in ambulatory medic. Orthopaedics differential diagnosis of buttockthigh pain. Walker has an extensive family history of gallstones involving his siblings and his mother. Nov 01, 2010 back pain is less common in younger children and then increases over time. Physicians and patients are confronted by a bewildering variety of treatment options for low back pain. Mechanical lbp refers to pain that is diffusely related to soft tissues. Pdf differential diagnosis of low back pain researchgate. Jan 16, 2019 lower back pain is one of the most prevalent sports maladies, affecting athletes in nearly every sport. It is important to detect neck pain caused by significant causes e. Chronic low back pain clbp is a chronic pain syndrome in the lower back region, lasting for at least 3 months. Apr 01, 2016 the current differential diagnostic methods generally do not enable a clear diagnosis to be made when low back pain is of muscular origin. Osteoporotic vertebral fracture should always be considered within the differential diagnosis of any nonspecific back pain.
Back pain is the primary cause of disability in people. When caring for a patient and developing a back pain differential diagnosis, remember to consider age, the history, physical exam findings, laboratory results, and imaging if needed. One study of consecutive general pediatric clinic visits in patients 315 years, found 4 patients presenting with back pain 0. An accurate diagnosis is essential for both acute and chronic low back pain conditions. Differential diagnosis of a patient referred to physical. Pdf differential diagnosis in upper back pain researchgate. Pdf on feb 21, 2015, nihal ozaras and others published differential diagnosis in upper back pain find, read and cite all the research you need on researchgate. It is associated with disability, health care expenses, and a loss of wages and productivity. Chronic pain, differential diagnosis, low back pain, neurostimulation. Pain can be moderate to severe and debilitating, causing anxiety. Suspicion of such back pain causes would warrant the physical therapist referring the patient to a physician. Differential diagnosis of low back pain sciencedirect. Its cause need not lie in the spine, as it can also be due to abdominal or pelvic disease.
Jan 14, 2016 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Clbp represents the second leading cause of disability worldwide being a major welfare and economic problem. The discussion in this article is extensive but not all. Back pain is the primary cause of disability in people back pain lbp is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Dont assume it has to be a tooth just because it usually is. The head and neck region is packed with complex anatomy, its. Back pain is the primary cause of disability in people lowback pain lbp is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Rarely, back pain is a harbinger of serious medical illness. Make a positive clinical diagnosis of low back pain and sciatica.
The first epi sode usually occurs between 20 and 40 years of age. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of back pain key historical findings onset acute onset. Differential diagnosis of low back pain article pdf available in seminars in pain medicine 23. There had been no vaginal bleeding, no change in bowel habit, and no urinary symptoms. The pain was colicky in nature, with no radiation, and it was worse when she was lying flat. Here we discuss about radicular pain, facet joint pain, sacroiliac pain, pain related to lumbar stenosis, discogenic pain. Low back pain is a symptom affecting millions of adults annually. Rootrelated pain can emerge from the tension events in the dura mater and nerve tissue associated. Patients who continue to have back pain beyond the acute period four weeks have subacute back pain lasting between 4 and 12 weeks and may go on to develop chronic back pain persists for. Liddle, md assistant professor of orthopedics assistant professor of internal medicine vanderbilt university medical center nashville, tn. Lower back pain is now a days common in males, especially in 50 or more than 50 years old males. The list of differential diagnoses for lower extremity pain is extensive and broad.
Low back pain has a lifetime prevalence of approximately 80%. The current differential diagnostic methods generally do not enable a clear diagnosis to be made when low back pain is of muscular origin. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Although its not lifethreatening it can cause serious problems. Approach to back pain department of family medicine 3 differential diagnosis of back pain mechanical lower back pain the most common cause of back pain. Diagnosis and treatment of acute low back pain aafp. Nov, 2014 the issue of low back pain lbp is as common as it is perplexing. Always be familiar with the childs medical history focused history of musculoskeletal pain timing of pain. The diagnostic approach to neck pain has not been as well studied as back pain, but a similar approach is recommended. Acute low back pain can be defined as six to 12 weeks. Differential diagnosis and treatment of visceral pain in the.
Differential diagnosis of low back pain mechanical low back pain or leg pain 97% lumbar strain 70% degenerative process of discs. In every patient with back pain, it is essential to systematically ask about and look for the clinical clues and pivotal points associated with serious causes of back pain table 71. Low back pain is the commonest cause for years lived with disability. The term low back pain refers to pain felt near the midline in the lumbar or sacral region. Differential diagnosis of back pain free download as powerpoint presentation. But not always if your diagnosis just isnt falling into any of our usual dental bins, back up and think about the rest of the body. Many authors suggest defining chronic pain as pain that lasts beyond the expected period of healing, avoiding. Evaluation of neck pain differential diagnosis of symptoms. Low back pain lbp is the most common musculoskeletal condition affecting the adult population, with a prevalence of up to 84% 1.
For many, acute low back pain is the first reason to seek medi cal care as an adult. Despite the availability of modern diagnostic tools, the cause of the pain generator is often unidentifiable. Oct 11, 2016 low back pain lbp is the most common musculoskeletal condition affecting the adult population, with a prevalence of up to 84% 1. The most important diseases that cause bone pain are listed in table 11. Diagnosing the cause of a back injury is quite difficult and challenging because multiple structures in the lower back region can cause pain.
You must check the presence of tendon on neck and motion of neck that aggravates or relieve the pain. Be sure to keep in mind the red flags for back pain. Pain originating from spinal nerve roots demonstrates multiple pathogeneses. Some estimates show that 8 out of 10 americans will experience back problems at some point during their lifetime. Imaging should be done only in specialist care settings and only if the result is likely to change management. Jan 24, 2017 mechanical low back pain is one of the most common patient complaints expressed to emergency physicians in the united states accounting for more than 6 million cases annually. Back pain is the most common cause of shortterm disability in adults younger than 45 years and the. True visceral pain is a physiologically and clinically separate entity from somatic pain. Chronic lbp clbp is a chronic pain syndrome in the lower back region, lasting for at least 12 weeks 2. The differential diagnosis of low back pain wiley online library. Walker because of the abdominal pain he has described, along with the rebound tenderness and guarding found on physical examination. The purpose of this report is to describe the role of differential diagnosis of hip from back pathology in a patient post lumbar laminectomy and fusion.
According to jarvik and deyo,23 in approximately 7% to 8% of patients with lbp, the cause is due to nonmechanical spinal conditions or visceral disease. Lbp is thought to be a chronic issue in approximately 10% of the u. The prevalence of mps among chronic back pain patients was 63. Feb 15, 2012 most persons will experience acute low back pain during their lifetime. Evaluation of back pain differential diagnosis of symptoms bmj. The etiology of low back pain may be difficult to determine at times because of the number of diverse anatomic structures located in or near the low back region. The patient was a 56yearold female seen in physical therapy two months postoperatively. Differential diagnosis of spondylolysis in a patient with. Figure 71 reorganizes the differential diagnosis using pivotalpoints and outlines the diagnostic approach to low back pain. Low back pain is the leading cause of long term disability worldwide. A thorough history and physical exam will aid the provider in identifying the correct diagnoses.
Pdf on feb 21, 2015, nihal ozaras and others published differential diagnosis in upper back pain find, read and cite all the research you need on. In every patient with back pain, it is essential to systematically ask about and look for the clinical clues and pivotal points associated with serious causes of back pain. Figure 71 reorganizes the differential diagnosis using pivotal points and outlines the diagnostic approach to low back pain. These structures may be causing direct or referred pain patterns. For many, acute low back pain is the first reason to seek. Distinctions in the pathoanatomy, biomechanics, and pathophysiology of spinal nerve roots contribute to pathology, diagnosis, and management of rootrelated pain. Lower extremity pain clinical guidelines for workup. Differential diagnosis and management of spinal nerve root. The first episode usually occurs between 20 and 40 years of age. Table 1 presents the differential diagnosis of acute low back pain. Here we shall focus on those areas of most relevance to primary and community care. A 26yearold male sought physical therapy services via direct access secondary to a flareup of a chronic low back pain condition. Back pain is a common presentation to the emergency department. Diagnosis and treatment of acute low back pain american.
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