View source for Back pain, bowel or bladder dysfunction and horner's syndrome

__NOTOC__
{{CMG}};{{AE}}{{HM}}

<span style="font-size:85%">'''Abbreviations:''' [[ABG]] = [[Arterial blood gases]], [[ANA]] = [[Antinuclear antibodies]], [[BUN]] = [[Blood urea nitrogen]], [[CRP]] = C-reactive protein, CT = [[Computed tomography]], DRA = Dual energy radiographic absorptiometry, DRE = [[Digital rectal exam]], [[ERCP]] = [[Endoscopic retrograde cholangiopancreatography]], [[ESR]] = [[Erythrocyte sedimentation rate]], HSV = [[Herpes simplex virus]], IVP = [[Intravenous pyelography]], KUB = Kidney, bladder, ureter, LDH = [[Lactate dehydrogenase]], LFT = [[Liver function test]], MRA = [[Magnetic resonance angiography]], MRC = [[Magnetic resonance cholangiopancreatography]], [[MRI]] = [[Magnetic resonance imaging]], MRU = Magnetic resonance urography, [[NSAID]]s = Non-steroidal anti-inflammatory drugs, PCR = [[Polymerase chain reaction]], [[PET]] - FDG = Positive emission tomography - fluorodeoxyglucose, [[PET]] = Positive emission tomography, PID = [[Pelvic inflammatory disease]], PSA = Prostatic specific antigen, PTC = [[Percutaneous transhepatic cholangiography]], [[RUQ]] = [[Right upper quadrant]], SPECT = Single-photon emission computed tomography, TFT = [[Thyroid function test]], VZV = [[Varicella zoster virus]]</span>


<small><small> 
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
|-
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain 
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
|-
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Neurological
![[Arachnoiditis]]<ref name="pmid10665863">{{cite journal |vauthors=Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM |title=CT of the brain in tuberculous meningitis. A review of 289 patients |journal=Acta Radiol |volume=41 |issue=1 |pages=13–7 |date=January 2000 |pmid=10665863 |doi= |url=}}</ref>
|Acute
|Hours
|Dull aching pain
|Head, neck and back
| +/-
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|CSF
* Elevated protein with normal or low [[glucose]]
Culture and sensitivity
* May be due to [[TB]] or [[Meningitis]]
Nucleic acid tests
* Helpful in tuberculous [[meningitis]]
|Radiography
* Thickened nerve roots
[[CT]]
* Narrowing of subarachnoid space
* Irregular collections of contrast material
* Thickened nerve roots
[[MRI]]
* Study of choice shows indistinct cord outline
|
* Usually caused by [[meningitis]] or [[TB]]
|-
![[Epidural abscess]]<ref name="pmid10201299">{{cite journal |vauthors=Nathoo N, Nadvi SS, van Dellen JR |title=Cranial extradural empyema in the era of computed tomography: a review of 82 cases |journal=Neurosurgery |volume=44 |issue=4 |pages=748–53; discussion 753–4 |date=April 1999 |pmid=10201299 |doi= |url=}}</ref><ref name="pmid14519222">{{cite journal |vauthors=Heran NS, Steinbok P, Cochrane DD |title=Conservative neurosurgical management of intracranial epidural abscesses in children |journal=Neurosurgery |volume=53 |issue=4 |pages=893–7; discussion 897–8 |date=October 2003 |pmid=14519222 |doi= |url=}}</ref>
|Acute
|Variable
|Dull, throbbing pain
|Locally
|<nowiki>-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|[[CBC]]
* May show [[leukocytosis]], left shift, [[thrombocytopenia]], and [[anemia]]
ESR
* Elevated
Culture and sensitivity
* To identify causative organism
Immunohistochemical staining
* Includes [[gram stain]], special stains for [[fungi]] and [[mycobacteria]], also consider [[brucella]]
|MRI
* Of choice and demonstrates fluid collection
CT
* Demonstrates fluid collection
Radiography
* Demonstrates [[osteomyelitis]] or vertebral collapse
|
* LP carries risk of spread of infection
|-
![[Radiculopathy]]<ref name="pmid8219542">{{cite journal |vauthors=Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS |title=A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis |journal=J Spinal Disord |volume=6 |issue=4 |pages=289–95 |date=August 1993 |pmid=8219542 |doi= |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Tarulli AW, Raynor EM |title=Lumbosacral radiculopathy |journal=Neurol Clin |volume=25 |issue=2 |pages=387–405 |date=May 2007 |pmid= |doi=10.1016/j.ncl.2007.01.008 |url=}}</ref>
|Acute
|Variable
|Severe, shooting pain
|Anterior thigh and knee
| +/-
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| -
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
| -
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|
* Typically no specific lab findings
|
Radiography
* To rule out serious underlying etiology
CT
* Demonstrates [[disc herniation]]
MRI
* Demonstrates [[disc herniation]] and nerve root impingement
Myelography
* Used preoperatively to visualize spinal anatomy accurately
Discography
* To localize a symptomatic disc
|
*[[Disc herniation]] is the most common cause of nerve impingement
|-
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
|-
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain 
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
|-
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Bone
|-
![[Degenerative disc disease]]<ref name="pmid2954221">{{cite journal |vauthors=Deyo RA, Tsui-Wu YJ |title=Descriptive epidemiology of low-back pain and its related medical care in the United States |journal=Spine |volume=12 |issue=3 |pages=264–8 |date=April 1987 |pmid=2954221 |doi= |url=}}</ref><ref name="pmid9523780">{{cite journal |vauthors=Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E |title=The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome |journal=Arch Phys Med Rehabil |volume=79 |issue=3 |pages=288–92 |date=March 1998 |pmid=9523780 |doi= |url=}}</ref>
|Subacute or chronic
|Years
|Dull aching
|Local
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|Serology
*[[HLA-B27]] may be positive or negative
*[[IgA]] may be elevated
*[[ANA]] may be positive
*[[Rheumatoid factor]] may be positive
[[CBC]]
*May indicate [[anemia]]
[[ESR]]
*May be elevated
[[CRP]]
*May be elevated
[[Uric acid]]
*May be elevated
|MRI
*Demonstrates delineation and position of vertebrae
CT
*Demonstrates delineation and position of vertebrae
*May also visualize nerve root compression and nerve swelling
Diskography
*Controversial, demonstrates [[disc herniation]]
|
*Transforaminal selective nerve root blocks are used diagnostically and therapeutically in cases presenting with [[radicular pain]]
|-
![[Spinal stenosis]]<ref name="pmid18287604">{{cite journal |vauthors=Katz JN, Harris MB |title=Clinical practice. Lumbar spinal stenosis |journal=N. Engl. J. Med. |volume=358 |issue=8 |pages=818–25 |date=February 2008 |pmid=18287604 |doi=10.1056/NEJMcp0708097 |url=}}</ref><ref name="pmid8600197">{{cite journal |vauthors=Ciol MA, Deyo RA, Howell E, Kreif S |title=An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations |journal=J Am Geriatr Soc |volume=44 |issue=3 |pages=285–90 |date=March 1996 |pmid=8600197 |doi= |url=}}</ref>
|Chronic
|Years
|Dull aching
|Hips and legs
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
*Typically no specific lab findings
|MRI
*Demonstrates narrowing of central canal, lateral recess, and neuronal foramina
CT
*Demonstrates narrowing of central canal, lateral recess, and neuronal foramina
|
*Premature imaging is strongly not recommended and may harm patient
*Normal aging process
|-
![[Spondylosis]]<ref name="pmid8817777">{{cite journal |vauthors=Yabuki S, Kikuchi S |title=Positions of dorsal root ganglia in the cervical spine. An anatomic and clinical study |journal=Spine |volume=21 |issue=13 |pages=1513–7 |date=July 1996 |pmid=8817777 |doi= |url=}}</ref><ref name="pmid2536306">{{cite journal |vauthors=Lestini WF, Wiesel SW |title=The pathogenesis of cervical spondylosis |journal=Clin. Orthop. Relat. Res. |volume= |issue=239 |pages=69–93 |date=February 1989 |pmid=2536306 |doi= |url=}}</ref>
|Chronic<ref name="pmid12380556">{{cite journal |vauthors=Storm PB, Chou D, Tamargo RJ |title=Surgical management of cervical and lumbosacral radiculopathies: indications and outcomes |journal=Phys Med Rehabil Clin N Am |volume=13 |issue=3 |pages=735–59 |date=August 2002 |pmid=12380556 |doi= |url=}}</ref>
|Years
|Dull aching
|Shoulders, arms, hips and legs
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
*Typically no specific lab findings
|Radiography
*Demonstrates osteophytes and disc-space narrowing
MRI
*Demonstrates the location of destruction and surrounding soft tissue
CT myelography
*Demonstrates osteophytes and calcified opacities
|
*Progresses with aging
|-
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
|-
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain 
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting
! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction
! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Miscellaneous
![[Physical trauma|Trauma]]<ref name="pmid20489662">{{cite journal |vauthors=Inaba K, DuBose JJ, Barmparas G, Barbarino R, Reddy S, Talving P, Lam L, Demetriades D |title=Clinical examination is insufficient to rule out thoracolumbar spine injuries |journal=J Trauma |volume=70 |issue=1 |pages=174–9 |date=January 2011 |pmid=20489662 |doi=10.1097/TA.0b013e3181d3cc6e |url=}}</ref>
|Acute or chronic
|Variable
|Severe, sharp to dull aching
|Variable
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
| +/-
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|After establishment of first aid protocol, the following lab tests may be useful;
Pregnancy test
*In women of child-bearing age
Blood typing, screening and cross matching
*In case of [[blood transfusion]]
Prothrombin time
*To assess those taking [[warfarin]]
Creatine kinase
*To determine incidence of [[rhadomyolysis]]
Blood sugar
*To determine [[hypoglycemia]]
Cardiac enzymes
*To determine incidence of [[myocardial infarction]]
Toxicology screen and alcohol level
*To determine alcoholism and drug use
Serum lactate
*Elevated serum [[lactate]] may indicate a serious injury
|To assess trauma, the following imaging may be used;
*Portable radiography
*Ultrasound
*CT
*Peritoneal tap or lavage
*Echocardiography
|
|-
|}
</small></small>








==References==
<references />