Differential diagnosis for low back pain june 8, 2004 10. Back pain that lasts 4 to 12 weeks is called subacute back pain. Psychosocial factors, including beliefs about injury, movement and recovery, are important in the development of back pain and disability. Some occupations, such as heavy lifters, miners and truck drivers, have an increased prevalence of back pain due to repetitive mechanical strain to the back. Many potential causes of hip pain have overlapping symptoms or physical exam findings. A discussion of the keys to correctly diagnosing and treating low back pain. If you indicate chronic morning stiffness, the analyst will ask further questions including this one. Data examined included demographic features of patients, duration of back pain, muscles involved, primary diagnosis, treatment modality and response to treatment. This will then lead to a list of differential diagnoses. Spinal pain sp can be grouped into three broad categories. Plain radiographs xrays, ct scan, andor mri studies are performed when fracture or neurologic dysfunction is suspected. Car accident back pain and no or miss diagnosis diagnosis. Bogduk 2003 management approach regardless of the primary source of pain, the prognosis for individuals experiencing chronic neck pain is poor, as many patients. Acute back pain clinical features and differential diagnosis.
Back pain is the most common cause of shortterm disability in. Table 1 provides a differential diagnosis of common problems presenting with fever and back pain. 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. Low back pain lbp is the fifth most common reason for physician visits, affects nearly 6080% of people throughout their lifetime. These structures may be causing direct or referred pain patterns. Low back pain lbp is the fifth most common reason for physician visits, which affects nearly 6080% of people throughout their lifetime.
Low back pain has a lifetime prevalence of approximately 80%. 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. 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. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. Differential diagnosis of pain around the hip joint. 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.
Differential diagnosis of a patient with low back and toe pain. Up to 85% of adults will experience low back pain at some point in their lives and back pain that lasts less than 6 weeks is considered acute back pain bhattarai et al. Mar 30, 2020 mechanical low back pain lbp remains the second most common symptomrelated reason for seeing a physician in the united states. Acute back pain has wide differential diagnoses, ranging from benign, selflimiting conditions to lifethreatening conditions. Pain of this type is perceived differently from patient to patient and is associated with variable symptoms and signs. Noninfectious causes of back pain like sacroileitis may have an infectious inciting event such as brucellosis or infections that are associated with reactive arthritis. Labsdiagnostics assessment differential diagnosis acute low. The differential diagnosis of pain around the hip and groin is broad and includes intraarticular pathology, extraarticular soft tissue and tendon pathology, and mimickers, including the joints that make up the pelvic ring. Low back pain is the commonest cause for years lived with disability. The patient experiences acute back pain with functional limitations and recurrences. An estimated 5080% of cases involving back and neck pain an underlying pathology cannot be definitively determined. Adult with low back pain or back related leg symptoms for diagnosis of low back pain is difficult and simply relying on an mri to diagnose low back pain is expensive and can be misleading. Lbp is thought to be a chronic issue in approximately 10% of the u.
It is the fifth most common reason for all physician visits in the us. I have since had symptoms that have gotten worse over the last 10 months. For many individuals, episodes of back pain are selflimited. If your primary physician is unable to make a pain diagnosis, request a referral to a specialist, either in chronic pain or in the part of the body or organ that is affected. Lower back pain symptoms and diagnosis spinehealth. Back pain is less common in younger children and then increases over time.
However, acute low back pain occurs frequently, and many of the conclusions of these guidelines remain relevant. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of back. It is associated with disability, health care expenses, and a loss of wages and productivity. The analyst is our online diagnosis tool that learns all about you through a straightforward process of multilevel questioning, providing diagnosis at the end. Some studies have shown that up to 23% of the worlds adults suffer from chronic low back pain. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of back pain key historical findings onset acute onset. The current differential diagnostic methods generally do not enable a clear diagnosis to be made when low back pain is of muscular origin. During my physical exam on patients with low back pain i can usually reproduce their low back pain with active and passive movements or i can reproduce their pain by manually pushing or moving the spine or during t. Jan 14, 2016 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Positive for arthritis positive for sleeping difficulties she smokes 12 pack a day and 4 packs a week she doesnt work out. Back pain is the most common cause of shortterm disability in adults younger than 45 years and the.
Imaging has limited utility because most patients with chronic low back pain have nonspecific findings on imaging studies,7 and asymptomatic patients often have abnormal 6findings. 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. In the differential diagnosis of low back pain, the main point is that 97% of cases are mechanical figure 1. Management and prevention is designed to help you understand the causes of low back pain and give you the strategies you need to manage it and even help prevent it. Specific causes of lbp are uncommon, and in approximately 90% of patients a specific generator cannot. There is a prevalence of back pain in the geriatric population greater than 70%. It will also show you how a physical therapist pt can help you stay healthy, in shape. Low back pain is one of the most commonly treated conditions by outpatient orthopedic physical therapists. Low back pain lbp is a common reason to visit the gp. The cause of back pain can usually be diagnosed with a detailed description of ones symptoms. The description of back pain symptoms, along with ones medical history and possibly diagnostic testing, will usually lead to a diagnosis of a general cause such as back strain, or a specific condition such as a herniated disc.
When a patient presents with a problem that appears likely to be mechanical, it may well be the case, but you need also to consider inflammatory conditions, infectious problems, fractures, referred and functional pain. Rarely, back pain is a harbinger of serious medical illness. Be sure to keep in mind the red flags for back pain. My doctor reported the mri to say they could not confirm the diagnosis of ms due to it being only a single lesion seen i was diagnosed by an ms clinic in another city. An accurate diagnosis is essential for both acute and chronic low back pain conditions. The issue of low back pain lbp is as common as it is perplexing. Alex brenner pt mpt ocs differential diagnosis for low back pain june 8, 2004 2. Differential diagnosis of low back pain article pdf available in seminars in pain medicine 23.
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. While one can estimate the age of an individual by examining an mri of the low back, one cannot say whether the subject has pain or not. Questions will be provided at end of blog post below case. One study of consecutive general pediatric clinic visits in patients 315 years, found 4 patients presenting with back pain 0. Acute low back pain management in general practice. Far better than just trying to leap to a list of possible causes of lbp. Terminology used in spine disc pathology and back pain differential diagnosis of low back pain risk factors for osteoporosis solitary nerve root lesions of the lumbosacral spine neurogenic vs vascular claudication manifestations of oa nonorganic low back pain signs waddell acp best practice advice lower back pain cancer tests for back pain. I recently have had unexplained neck painspasm with intermittent pounding in my ears and visual flashes of light at times. Labsdiagnostics assessment differential diagnosis acute. There are published guidelines for the diagnosis and treatment of low back pain.
Differential diagnosis for back pain chronic oxford. Despite the availability of modern diagnostic tools, the cause of the pain generator is often unidentifiable. Cauda equina symptoms n back pain with nerve root distribution of pain one or more nerve roots involved n sciatica n saddle parathaesia and or anesthesia around the anus, perineum or genitals n faecal incontinence n bladder dysfunction e. Approach to fever and back pain infectious disease and. Of the us population, 85% will experience an episode of mechanical lbp at some point during their lifetime. Adult with low back pain or back related leg symptoms for clinical features and di. Differential diagnosis of low back pain sciencedirect. Powered by create your own unique website with customizable templates. Differential diagnosis for back pain chronic common and important causes of back pain chronic for doctors and medical students this page is currently being written and will be available soon. Hing differential diagnosis and classification of neck.
Explain the value of a cardiovascular history, the value and limitations of ecg, troponin, and other point of care diagnostics relate how to develop a differential diagnosis for a patient presenting with chest pain. During my physical exam on patients with low back pain i can usually reproduce their low back pain with active and passive movements or i can reproduce their pain by manually pushing or moving the spine or during the tests and measures portion of. Mechanical low back pain lbp remains the second most common symptomrelated reason for seeing a physician in the united states. Back pain is a common presentation to the emergency department. Low back pain share this page pain in the lower back area that can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, or the skin covering the lumbar area. Low back pain differential diagnosis ppt 2019 back pain. This population has also shown a oneyear recurrence rate of 24% to 80%.
I have started having what i think are panic attacks as well. As well the left eye creates a straight line into a jagged one. During my physical exam on patients with low back pain i can usually reproduce their low back pain with active and passive movements or i can reproduce their pain by manually pushing or moving the spine or during the tests and measures portion of the exam. I have dizziness, severe neck pain with pain radiating from the back of my headneck, terrible pain or numbness and tingling alternating in my arms and legs. The description of back pain symptoms, along with ones medical history and possibly diagnostic testing, will usually lead to a diagnosis of a general cause such as back strain, or a specific condition such as a herniated disc back pain symptoms from a sprain or strain.
Costs associated with lbp represent a major financial burden in developed countries 1,46. Back mouse ehlers danlos hypermobility syndrome vitamin d deficiency bertolottis syndrome back pain in the setting of a transitional vertebra thinking through the differential diagnosis acute back pain is back pain. Nov 01, 2010 back pain is less common in younger children and then increases over time. It should also be considered that fever may be associated with the condition. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Table 1 presents the differential diagnosis of acute low back pain.
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