Back Pain, Acute

 

1. Approach to the evaluation of acute back pain:

a) Given how common of a complaint back pain is (~70% of patients complain of it at some point), it is crucial to determine whether any symptoms are present that might implicate systemic or visceral disease.

b) Red flags include:

      - Hx malignancy

      - Age >70

      - Recent trauma

      - Unexplained weight loss

      - Unexplained fever

      - Immunosuppression

      - IVDU

      - Osteoporosis or prolonged steroid use

      - Duration of pain >6 weeks

      - Progressive sx unresponsive to prior therapies

c) Neuro exam should focus on detecting any compromise, and localizing the deficit.

      - UMN signs: weakness, hyperreflexia, increased tone

      - LMN signs: weakness, hyporeflexia, decreased tone, atrophy, fasiculations

      - Reflexes:

         - Patellar: L2-L4

         - Ankle: S1

         - Babinski: L5, S1, S2

 

 

2. Differential diagnosis of back pain:

a) Musculoskeletal

b) Visceral disease

      - Pelvic (prostatitis, endometriosis, PID)

      - Renal (nephrolithiasis, pyelonephritis, perinephric abscess)

      - AAA

      - GI (pancreatitis, cholecystitis, PUD)

c) Systemic disease

      - Neoplastic

      - Infectious (epidural abscess, osteomyelitis, endocarditis)

      - Seronegative spondyloarthorpathies

 

 

 

(Christopher Woo MD, 7/13/10)