Back pain differential diagnosis: Difference between revisions

Latest revision as of 14:21, 18 May 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

An expert algorithm to assist in the diagnosis of back pain can be found here

Overview

There are several life-threatening causes of back pain, including spinal cord or cauda equina compression, aortic dissection, aortic aneurysm, vertebral osteomyelitis, epidural abscess, and metastatic cancer. These should be evaluated alongside other possible causes of back pain by carefully assessing the nature of the pain, and obtaining a thorough patient history.

Differential Diagnosis of Back Pain

The following table outlines the major differential diagnoses of back pain.

To review the differential diagnosis of back pain and bowel or bladder dysfunction, click here.

To review the differential diagnosis of back pain, bowel or bladder dysfunction and horner's syndrome, click here.

To review the differential diagnosis of back pain and fever, click here.

To review the differential diagnosis of back pain, fever and stiffness, click here.

To review the differential diagnosis of back pain and heart murmur, click here.

To review the differential diagnosis of back pain and headache, click here.

To review the differential diagnosis of back pain and horner's syndrome, click here.

To review the differential diagnosis of back pain and motor weakness, click here.

To review the differential diagnosis of back pain, motor weakness and sensory deficit, click here.

To review the differential diagnosis of back pain and nausea and vomiting, click here.

To review the differential diagnosis of back pain and pulse deficit, click here.

To review the differential diagnosis of back pain and sensory deficit, click here.

To review the differential diagnosis of back pain and stiffness, click here.

To review the differential diagnosis of back pain and syncopy, click here.

To review the differential diagnosis of back pain and weight loss, click here.

To review the differential diagnosis of back pain exhibiting "red flags", click here.

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, NSAIDs = 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

Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Vascular	Retroperitoneal hematoma^[1]^[2]^[3]	Acute or subacute	Minutes to hours	Sharp and knife-like, also tearing or ripping	Back and/or flanks	-	-	-	-	+/-	-	-	-	-	-	-	-	-	Typically no specific lab findings, however, evidence of hemorrhage and organ injury may be seen in: Complete blood count; normochromic normocytic anemia seen in hemorrhage Elevated serum electrolytes Elevated liver function tests Elevated amylase or lipase	CT with IV contrast May show venous delay and indicate renal trauma Cystography Should be considered in evaluation of hematuria and pelvic injury	Mostly caused by automobile accidents
Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Neurological	Arachnoiditis^[4]	Acute	Hours	Dull aching pain	Head, neck and back	+/-	+	+/-	+/-	+/-	+/-	+/-	+/-	+/-	-	-	+/-	+/-	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
	Cauda equina syndrome^[5]^[6]	Acute	Hours	Severe, sharp local pain	Rarely to sacroiliac joint	-	-	-	-	-	-	-	+	+/-	-	-	+/-	-	CBC To rule out anemia Electrolytes, blood urea nitrogen, and creatinine To rule out renal failure and retroperitoneal hematoma Erythrocyte sedimentation rate To rule out inflammatory origin Syphilis serology To rule out meningovascular syphilis	Radiography May show vertebral erosions MRI Of choice and may show nerve root abnormalities Duplex For vascular abnormalities Lumbar puncture For inflammation	Electrical studies: EMG Done to rule out acute denervation SSEPs Done to rule out multiple sclerosis
	Epidural abscess^[7]^[8]	Acute	Variable	Dull, throbbing pain	Locally	-	+/-	+/-	+/-	+/-	+/-	+/-	+/-	+/-	-	-	+/-	+/-	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^[9]^[10]	Acute	Variable	Severe, shooting pain	Anterior thigh and knee	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	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
	Sciatica^[11]^[12]^[12]	Acute	Minutes to hours	Severe, shooting pain	Posterior thigh, buttocks and knee	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	To exclude other pathologies CBC with differential ESR Alkaline and acid phosphatase level Serum calcium level Serum protein electrophoresis	Radiography With technetium-99m labeled phosphorus to indicate bone mineralization status 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	May have a psychological component
	Spinal cord compression^[5]^[6] - Thoracic spine - Lumbar spine	Acute	Minutes to hours	Severe and localized	Locally, may radiate below lesion	-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	Neoplasm must be suspected and is ruled out by CBC - May demonstrate a pancytopenia Prothrombin time and activated partial thromboplastin time - May be prolonged Metabolic profile, including calcium level and liver function - May indicate metastasis	MRI May demonstrate tumors and collapse of intervertebral spaces May distinguish between bone lesions and malignancy Radiography May demonstrates bony destruction or calcification Nuclear imaging To identify neoplasms	Aggressive radiotherapy is often needed
Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Bone	Ankylosing spondylitis^[13]^[14]	Subacute or chronic	Years	Dull aching pain	Local	+	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings	MRI Demonstrates both inflammatory and structural lesions CT Useful in identifying structural lesions Radiography Useful in identifying structural lesions Doppler ultrasound To detect active esthesitis	Extra-articular manifestations are common and include Uveitis CVD Respiratory disease Renal disease Neurologic disease GI disease Metabolic bone disease Often affecting a young male
	Bertolotti's syndrome^[5] (Lumbosacral transitional vertebrae)	Chronic	Years	Dull aching pain	Local	-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings	MRI Of choice and demonstrates transitional vertebra CT Demonstrates vertebral transition Radiography Demonstrates vertebral transition	Congenital anomaly and may be asymptomatic
	Chronic recurrent focal osteomyelitis^[15]^[16]^[17]	Chronic	Years	Dull aching pain	Local	+/-	+	+	-	-	-	+/-	-	-	-	-	-	-	CBC Leukocytosis and left shift ESR Elevated CRP Elevated Procalcitonin Elevated Culture and sensitivity To identify causative agent	Radiography Demonstrates endosteal or medullary lesion Sequestration and cavity formation MRI Bone marrow abnormalities and lytic changes CT Articular and periarticular involvement Ultrasound Soft tissue abnormalities Nuclear imaging Loss of bone density	Acute presentation is often seen in children and is associated with gait abnormalities
	Cervical fracture^[18]^[19]	Acute	Minutes to hours	Severe, sharp	Shoulder and arm	-	-	-	+/-	-	-	-	+/-	+/-	-	-	-	+/-	Typically no specific lab findings	Radiography May demonstrate fracture of the vertebrae and/or preexisting pathology that may have lead to fracture CT May show pathology that was not noted on radiography MRI May show pathology that was not noted on radiography	If suspected should be stablized immediately
	Degenerative disc disease^[20]^[21]	Subacute or chronic	Years	Dull aching	Local	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	+/-	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
	Disc herniation^[22]^[23]	Acute	Minutes to hours	Sharp,shooting	Legs and hips	-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	Typically no specific lab findings	MRI Demonstrates the size and location of the herniated disc and surrounding soft tissue CT myelography Useful in lateral herniations with calcification Radiography Demonstrates osteophytes, disc-space narrowing, and kyphosis Discography Controversial, may show endplate irregularites or annular tears	Often presents with parathesias and no pain
	Discitis^[24]^[25]	Chronic	Years	Dull aching or throbbing	Local	-	+	+/-	-	+/-	-	+/-	+/-	+/-	-	-	+/-	-	CBC May demonstrate leukocytosis ESR May be elevated CRP May be elevated Procalcitonin May be elevated Culture and sensitivity To identify causative agent	MRI Narrowing of disk space and low signalling indicates edema CT Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus Radiography Disk space narrowing with destruction of endplates and calcification of annulus Nuclear imaging Focal uptake of gallium-67 and technetium-99m in area of destruction	Most likely due to hematogenous spread of organism
	Hyperkyphosis^[26]^[27]	Chronic	Years	Dull aching	Local	+/-	-	-	-	-	-	-	+/-	+/-	-	-	-	-	Typically no specific lab findings, however; CBC may be done to rule out other serious pathologies.	Radiography Wedge-shaped vertebrae Narrow intervertebral disk spaces with calcifications Prominent irregularities of vertebrae Arcuate kyphosis	Often begins as loss of height with normal aging
	Osteoarthritis^[28]^[29]^[30]	Chronic	Years	Dull aching	Local	+	-	-	-	-	-	-	-	-	-	-	-	-	ESR Elevated CRP Elevated Synovial fluid analysis WBCs < 2000/mm3 Polys < 25% Culture negative Crystal negative Elevated IL-2, IL-5, MCP-1	Radiography Asymmetric joint space narrowing Subchondral sclerosis Subchondral cysts MRI Joint space narrowing Degeneration	Gradual onset Polyarthritis Hips, knees, distal and proximal interphalyngeal joints and spine involvement Bouchard's and Heberden's nodes
	Sacroiliac joint dysfunction^[31]^[32]	Chronic	Years	Dull aching	Hips and legs	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	CBC May show leukocytosis ESR May be elevated CRP May be elevated Serology ANA Rheumatoid factor HLA-B27 Metabolic panel May indicate hypothyroidism or cortisol abnormalities	Imaging is controversial, however, CT may demonstrate; Reactive spurs Sclerosis Subluxation MRI Used primarily to exclude disc herniation Nuclear imaging Used to rule out stress fractures and metastatic bone disease	Rehabilitation is often sought
	Sacroilitis^[32]^[33]	Acute or chronic	Variable	Dull aching or throbbing	Hips and legs	+/-	+	+/-	-	-	-	+/-	+/-	+/-	-	-	+/-	-	CBC May demonstrate leukocytosis ESR May be elevated CRP May be elevated Procalcitonin May be elevated Culture and sensitivity To identify causative agent	MRI Narrowing of joint space and low signalling indicates edema CT Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface Radiography Joint space narrowing with destruction of joint space Nuclear imaging Focal uptake of gallium-67 and technetium-99m in area of destruction	Most likely due to hematogenous spread of organism
	Scheuermann (juvenile) kyphosis^[34]^[35]	Chronic	Years	Dull aching	Shoulders and arms	+/-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings	Radiography Wedge-shaped vertebra Arcuate kyphosis Narrow intervertebral discs with calcifications Prominent irregularities of the vertebrae Vertebral plates are underdeveloped and demonstrate multiple herniations of the nucleus pulposus (Schmorl nodes)	Schmorl nodes are also seen in Wilson's disease and are not specific
	Scoliosis^[36]^[37]^[38]	Chronic	Years	Dull aching	Shoulders, arms, hips and legs	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	-	Typically no specific lab findings	Radiography Bending of the thoracic curve is noted MRI Used to assess additional complaints such as headaches, not routine for adolescents	Most commonly is idiopathic
	Spinal stenosis^[39]^[40]	Chronic	Years	Dull aching	Hips and legs	+/-	-	-	-	-	-	-	+/-	+/-	-	-	+/-	+/-	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^[41]^[42]	Chronic^[43]	Years	Dull aching	Shoulders, arms, hips and legs	+/-	-	-	+/-	-	-	-	+/-	+/-	-	-	+/-	+/-	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
	Vertebral compression fracture^[44]^[45]^[46]	Acute	Minutes to hours	Sudden, severe, sharp	Shoulders, arms, hips and legs	+/-	-	-	+/-	+/-	+/-	-	+/-	+/-	-	-	+/-	-	CBC Decreased hematocrit and anemia PSA To rule out prostate cancer Urine analysis To detect Bence - Jones protein Serum protein electrophoresis M spike is seen with multiple myeloma ESR May be elevated	Radiography Decreased vertebral body height CT Detects more subtle fractures and calcifications MRI Useful in those with motor weakness and sensory deficits May demonstrate hemorrhage, tumor, or infection DRA scanning Detects low bone density PET scanning To distinguish benign from malignant causes of compression	Presents as a midline back pain
	Vertebral osteomyelitis^[47]^[48]^[49]	Acute	Minutes to hours	Sudden, severe, sharp	Shoulders, arms, hips and legs	+/-	+	+/-	-	+/-	-	-	+/-	+/-	-	-	+/-	-	CBC Leukocytosis and left shift ESR Elevated CRP Elevated Procalcitonin Elevated Culture and sensitivity To identify causative agent	Radiography Demonstrates endosteal or medullary lesion Sequestration and cavity formation MRI Bone marrow abnormalities and lytic changes CT Articular and periarticular involvement Ultrasound Soft tissue abnormalities Nuclear imaging Loss of bone density	Often caused by hematogenous spread of organism
Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Referred pain	Aortic aneurysm rupture^[50]^[51]^[52] - Abdominal aortic aneurysm - Thoracic aortic aneurysm	Acute	Minutes to hours	Sharp and knife-like, also tearing or ripping	Back and/ or flanks	-	-	-	-	-	+/-	-	-	-	+	+/-	-	-	Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in: Complete blood count; normochromic normocytic anemia seen in haemorrhage Elevated serum electrolytes Elevated liver function tests Elevated amylase or lipase	Ultrasonography Visualization of aneurysm, size and/or rupture and hematoma Chest radiography Visualizes calcifications in aneurysm but not specific CT Demonstrates aortic size, extent, and involvement of organ arteries MRI Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT Angiography Allows 3D construction of aorta Echocardiography (Transesophageal) Demonstrates fluid shift and need for cardiology intervention	Livedo reticularis may be seen and indicates thrombotic phenomenon
	Aortic dissection^[53]^[54]^[55]^[55]^[56]^[57]	Severe and sudden (acute) and rarely, chronic	Minutes to hours	Sharp and knife-like, also tearing or ripping	Back and/or flanks	-	-	-	-	-	+/-	-	-	-	+	+/-	-	-	Elevations in: D - dimer Smooth muscle myosin heavy chain Soluble ST2 Soluble elastin fragments High -sensitivity C-reactive protein Fibrinogen Fibrillin fragments	ECG: Normal Non - specific ST wave changes Hypertrophy patterns ST segment elevation indicating myocardial infarction Chest radiography: Normal Mediastinal or aortic widening	Increased risk of occurence with Marfan syndrome
	Appendicitis^[58]^[59]^[60]	Acute	Minutes to hours	Burning	Umbilicus and lower right quadrant	-	+	+/-	-	+	-	-	-	-	-	-	-	-	CBC Demonstrates leukocytosis and neutrophilia CRP May be elevated Urine analysis May demonstrate pyuria, hematuria, and/or proteinuria Urine 5-HIAA Maybe an early marker of appendictis Sudden increase may indicate necrosis	Ultrasound Demonstrates a non-compressible tubular structure CT Demonstrates an enlarged appendix with thickened walls and can detect abnormally located appendices MRI Useful in pregnant ladies KUB Radiography May detect an appendicolith Barium enema Demonstrates absent or incomplete filling Cecal spasm may be present Radionuclide scanning Appendiceal inflammation may be present	Pain begins around the umbilicus and then shifts to RUQ
	Cholelithiasis^[61]^[62]	Acute or subacute	Minutes or hours	Sharp	Tip of right shoulder	-	+/-	+/-	-	+	-	+/-	-	-	-	-	-	-	CBC Demonstrates polymorphnuclear leukocytosis LFT Elevated alanine aminotransferase and aspartate aminotransferases Elevated conjugated bilirubin Amylase and lipase Elevated	Radiography Radio-opaque stones may be present CT May indicate presence of gallstones in the distal common bile duct MRI May indicate presence of gallstones in the distal common bile duct Ultrasound May demonstrate gallbladder wall thickening (>5 mm) and gallbladder fluid and distention Gallstones may appear as echogenic foci that cast an acoustic shadow Scintigraphy May detect cystic duct obstruction ERCP Stones are seen as a filling defect and can be removed simultaneously PTC Similar to ERCP Used when ERCP is not feasible	May be completely asymptomatic
	Chronic stable angina^[63]^[64]	Chronic	Variable	Discomfort in the chest	Left shoulder, arm and jaw	-	-	-	-	+/-	+/-	-	-	-	+/-	-	-	-	Detection of: Urinary proton nuclear magnetic resonance spectroscopy Toll-like receptors 2 and 4 (TLR-2 and TLR-4) on platelets	Chest radiography Normal, may show calcification or complications such as pleural effusion Exercise stress testing Establishes diagnosis and extent of angina Stress Echo To evaluate wall motion, normal in stable angina Nuclear imaging To assess myocardial perfusion, reduced in stable angina CT To evaluate coronary artery calcium (cac) which may or may not be elevated CT Angiography To evaluate stenosis, <70% in stable angina EKG Normal in stable angina	Hallmark is relief by rest or sublingual nitroglycerin
	Cystitis^[65]^[66]^[67]	Acute	Hours	Burning	Suprapubic	-	+/-	+/-	-	-	-	-	-	-	-	-	+/-	-	Urine analysis May demonstrate [[pyuria[[, hematuria, white blood cell casts and proteinuria Urine culture Detection of > 1000 colony-forming units/ml CBC May demonstrate leukocytosis and/or anemia	Typically no routine imaging done	Cystitis may be infectious, hemorrhagic, radiational, or sterile
	Endocarditis^[68]^[69]^[70]	Acute or subacute	Variable	Discomfort in the chest	Jaw and arms	-	+/-	+/-	-	+/-	+/-	-	-	-	+/-	+	-	-	CBC Anemia and leukocytosis may be noted Serology Decrease C3, C4, and CH50 may indicate subacute endocarditis Rheumatoid factor may be positive ESR May be elevated Urine analysis May demonstrate proteinuria and microscopic hematuria Blood culture To identify causative agent Streptococci and HACEK organisms are culture negative Organisms that grow on prosthetic valves tend to be coagulase-negative staphylococci	Echocardiography Vegetations and myocardial abscesses may be present Radiography Pyogenic emboli may be seen across the lung field Ultrasound Myocardial abscesses may be seen Valvular dysfunction may also be noted	IV drug users and those who suffer from rheumatic heart disease often present with infective endocarditis
	Myalgia^[71]^[72]^[73]	Chronic	Years	Dull aching	Variable	+/-	+/-	+/-	+/-	-	-	-	-	-	-	-	-	-	*Typically no specific lab findings A full workup should be done to exclude other etiologies, such as; Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies May indicate cause is rheumatoid arthritis CRP and ESR May be elevated CBC May indicate anemia Bone profile May be caused by a vitamin D or calcium deficiency	Typically no routine imaging done	May be associated with Hepatitis C and Lyme disease
	Nephrolithiasis^[74]^[75]^[76]	Acute	Hours	Severe, sharp	Abdomen, hips, groin, legs	-	+/-	+/-	-	+/-	-	-	-	-	-	-	-	-	CBC Mild leukocytosis may indicate infection Electrolytes Hypokalemia may indicate acute tubular necrosis Hypercalcemia or hypercalciuria may be detected Creatinine To identify potential renal injury with contrast Uric acid Uric acid stones sometimes occur with gout ABG May indicate acute tubular necrosis with hypokalemia and decreased bicarbonate	CT Visualizes calcium stones and other possible pathologies, such as hydronephrosis IVP Visualizes stones and entire urinary system KUB radiography Radio-opaque stones may be present Ultrasound For visualization of stones Plain renal tomography Can distinguish between intrarenal and extrarenal calcifications Retrograde pyelography Particularly useful for ureteric calculi visualization Nuclear renal imaging May determine a decreased renal function	Hypercalcemia may indicate primary or secondary hyperparathyroidism
	Pancreatitis^[77]^[78]^[79]	Acute or chronic	Variable	Severe, sharp or dull aching	Abdomen	-	+/-	+/-	-	+	+/-	+/-	-	-	-	-	-	-	Amylase and lipase Elevated LFT Elevated alkaline phosphatase, total bilirubin, aspartate aminotransferase, and alanine aminotransferase CBC May demonstrate leukocytosis Serum electrolytes May indicate hypo or hypercalcemia BUN and creatinine May be elevated Triglycerides Usually elevated, however, falsely lowered during acute attack	KUB radiography May demonstrate free air within abdomen, indicating a perforated viscus Ultrasound Used to visualize the pancreas and biliary tree May detect microlithiasis and periampullary lesions CT Pancreas may appear enlarged MRC May demonstrate a blockage within the biliary ducts ERCP May remove a blockage, however, can in fact cause pancreatitis	Usually caused by binge drinking or long standing gallstones that block the ampulla of Vater Vomiting is a common manifestation
	Pelvic inflammatory disease^[80]^[81]^[82]	Acute or chronic	Variable	Dullaching or throbbing	Hips, groin, legs	-	+/-	+/-	-	+/-	-	-	-	-	-	-	-	-	CBC Leukocytosis, may indicate infection with trichomoniasis Pregnancy test To rule out ectopic pregnancy STD panel To rule out gonorrhea, chlamydia, hepatitis B and C, HIV, and syphilis Urine analysis To rule out a urinary tract infection	Transvaginal ultrasound May demonstrate anechoic structures in adnexa indicating hydrosalpinx and/or pyosalpinx Laparoscopy May demonstrate adhesions (Asherman's syndrome) or gun powder lesions (Endometriosis) or an ectopic pregnancy MRI and CT May indicate hydro and/ or pyosalpinx	Inflammation may spread to perihepatic structures (Fitz-Hugh−Curtis syndrome)
	Pulmonary embolism^[83]^[84]^[85]	Acute	Minutes	Severe, sharp	Chest and back	-	-	-	+/-	+/-	+/-	-	-	-	+/-	+/-	-	-	Lab findings are not specfic and are done to rule out other diseases such as: Antithrombin III deficiency Protein Cor protein S deficiency Lupus Homocystinuria Malignancy Connective tissue disorders	D - dimer is positive and ventilation- perfusion scanning will show a a perfusion/ventilation mismatch CT Angiography and duplex angiography are able to visualize the embolism	PE may occur even in patients that are fully anticoagulated DVT is a common source
	Pyelonephritis^[86]	Acute or chronic	Variable	Severe, sharp or dull aching	Groin, hips and legs	-	+	+/-	-	+/-	-	-	-	-	-	-	+/-	-	CRP Elevated ESR Elevated Urinalysis Pyuria Bacteriuria May be nitrite positive (gram negative organisms) Culture positibe (Uncomplicated: E. coli, Proteus mirabialis, Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis	Ultrasound Hydronephrosis Non-contrast CT Pelvicalceal dilation Cortical involvement MRI T1: affected region(s) appear hypointense compared with the normal kidney parenchyma T2: hyperintense compared to normal kidney parenchyma T1 C+: reduced enhancement	Renal stones Obstruction Pregnancy Prolonged urinary catheterization
	Pneumonia^[87]^[88]^[89]	Acute or chronic	Variable	Variable	Chest, back and abdomen	-	+	+	+/-	+/-	+/-	+/-	-	-	-	-	-	-	CBC Leukocytosis is often demonstrated however, white blood cell count may be normal Blood culture To identify causative organism or rule out other organisms such as MRSA	Radiography Plain x-ray shows multiple patches in the lung fields CT Used to distinguish pneumonia from non-pneumonias	Hospital-acquired pneumonia is common
	Pyomyositis^[90]^[91]^[92]^[93]	Acute or chronic	Days to weeks	Dull aching or throbbing	Variable	-	+	+/-	-	-	-	-	-	-	-	-	-	-	CBC Demonstrates leukocytosis ESR Elevated Serum creatine kinase and aldolase Normal Blood culture Typically negative Culture and sensitivity May include a positive gram stain	MRI Can differentiate between osteomyelitis and pyomyositis by demonstrating early muscle inflammation or abscess formation CT May demonstrate pphypertrophy]] of muscles and/or effacement of fatty plane An enhancement in contrast may indicate abscess formation Ultrasound Useful in determining specific muscle involvement Gallium scan Useful in detecting early muscle pathology	Infectious myositis was once considered a tropical disease, however with the emergence of HIV is now prevalent in western societies too
	Rheumatoid arthritis^[94]^[95]^[96]	Chronic	Years	Severe, aching	Variable	+	-	-	-	-	-	+/-	-	-	-	-	-	-	ESR and CRP Elevated CBC May indicate anemia Rheumatoid factor May be positive ANA May be positive Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin (anti-MCV) Are specific to rheumatoid arthritis	Radiography Osteopenia is noted Metacarpal bone erosion Narrow joint space without osteophytes MRI Pannus formation may be noted Ultrasound Effusion of joint may be seen	Symmetric polyarthritis Morning stiffness with improvement throughout the day Deformities of the hand are common
	Traumatic aortic rupture^[97]^[98]	Acute	Minutes to hours	Sharp and knife-like, also tearing or ripping	Back and/ or flanks	-	-	-	-	-	+/-	-	-	-	+/-	+/-	-	-	Typically no specific lab findings, however, evidence of hemorrhage and organ injury may be seen in: Complete blood count; normochromic normocytic anemia seen in hemorrhage Elevated serum electrolytes Elevated liver function tests Elevated amylase or lipase	Ultrasonography Visualization of rupture, size and hematoma CT Demonstrates intimal flap, hematoma, filling defect, aortic contour abnormality, pseudoaneurysm, vessel wall disruption, and extravasation of intravenous contrast MRI Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT Angiography Allows 3D construction of aorta Echocardiography (Transesophageal) Demonstrates fluid shift and need for cardiology intervention	Mostly caused by automobile accidents
	Waterhouse-Friderichsen syndrome^[99]^[100]	Acute	Minutes to hours	Sudden, severe, sharp	Back and/or flanks	-	+	+/-	+/-	+/-	+/-	+/-	-	-	-	-	-	-	CBC May show decreased hemotocrit, leukocytosis and rarely, eosinophilia Serum electrolytes Hyponatremia Hyperkalemia Hypercalcemia Blood urea nitrogen Elevated Creatinine Elevated Plasma glucose Hypoglycemia Serum cortisol Decreased Plasma ACTH Elevated	CT Shows adrenal enlargement or adrenal aymmetry	Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis
Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Tumors	Ewing's sarcoma^[101]^[102]^[103]	Chronic	Months to years	Dull aching	Variable	+/-	+/-	+/-	-	-	-	+	-	-	-	-	-	-	Tests are used to rule out other pathologies; CBC May indicate anemia Blood cultures May be positive for various organisms ESR and CRP May be elevated LDH May be elevated Cytogenetic studies May be positive for t(11;22) translocation Immunohistochemical markers May be positive for MIC2 antigen (CD99)	Radiography Periosteal reaction "onion skin" Cortical thinning Mottling MRI Skip lesions Edema Metastasis PET - FDG To identify metastatic disease
	Langerhans cell histiocytosis^[104]^[105]^[106]^[106](eosinophilic granulomas)	Chronic	Months to years	Dull aching	Variable	-	+/-	+/-	-	-	-	-	-	-	-	-	-	-	Tests used to rule out other pathologies; CBC Reticulocyte count may be increased Positive or negative direct and indirect Coombs test Immunoglobulin levels may be elevated ESR May be elevated LFT May demonstrate elevations in total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase Elevations may mean liver cirrhosis Urine analysis Decrease in urine osmolality may indicate diabetes insipidus	Radiography Single or multiple osteolytic lesions may be noted CT To identify abnormalities of the hypothalamic and/or pituitary region MRI To identify abnormalities of the hypothalamic and/or pituitary region PET - FDG More sensitive than CT or MRI to active disease
	Leukemia^[107]^[108]^[109]^[110]	Acute or chronic	Weeks to years	Aching	Variable	-	+/-	+/-	-	-	-	+	-	-	-	-	-	-	CBC Mature or immature leukocytosis Coagulation study May demonstrate elevatedprothrombin time, decreasing fibrinogen level, and presence of fibrin split products Peripheral blood smear May demonstrate blasts, ppschistocyte]]s, auer rods, and mature lymphocytosis Blood chemistry profile May demonstrate tumor lysis syndrome through elevated LDH and uric acid Blood culture To rule out infection	Typically no routine imaging studies, cytogenetic and flow cytometries aid diagnosis	Acute and chronic, lymphocytic and myeloid diagnoses are based on the presence and type of blast or mature cell
	Lymphoma^[111]^[112]^[113]^[114]	Chronic	Months to years	Aching	Variable	-	+/-	+/-	-	-	-	+	-	-	-	-	-	-	Typically no specific lab findings, however, the following routine tests are performed; CBC Serum chemistry studies, including LDH Serum beta2-microglobulin level HIV serology	Radiography May demonstrate hilar or mediastinal adenopathy Pleural or pericardial effusion Parenchymal involvement Bulky mediastinal mass CT May demonstrate enlarged lymph nodes Hepatosplenomegaly Filling defects in visceral organs Bone scan Useful in those with elevated alkaline phosphatase Gallium scan May show increased uptake MRI Signal intensity changes are noted in those with bone marrow or muscular involvement PET - FDG To distinguish between viable, active tumors and necrosis To detect early recurrence Ultrasound Useful if primary lesion is in testis	Hodgkin's lymphoma is usually focal and characterized by Reed-sternberg cells Non - hodgkin's lymphoma tends to be multifocal Biopsy provides ultimate diagnosis
	Multiple myeloma^[115]^[116]	Chronic	Years	Dull aching	Hips, groin and legs	+/-	+/-	+/-	-	-	-	+/-	-	-	-	-	+/-	-	Serum protein electrophoresis May demonstrate a M peak Serum free light chain assay and 24 - hour urine collection May detect Bence-Jones proteins CRP May be elevated Serum beta2-microglobulin May be elevated Albumin May demonstrate elevated albumin in urine LDH May be elevated Peripheral blood smear May demonstrate rouleaux formation > 50% Leukopenia Thrombocytopenia	Radiography, MRI and PET Osteolytic lesions may be demonstrated	Biopsy will demonstrate elevated plasma cells in the bone marrow
	Neurofibroma^[117]	Chronic^[118]^[119]	Weeks to years	Aching, pressure	Variable	-	-	-	-	-	-	-	-	-	-	-	-	-	Molecular sequencing Used to detect neurofibromin gene Urine analysis Used to detect free catecholamine and their metabolites in suspected pheochromocytoma	Radiography Bowing of bones Medullary destruction MRI and CT Used to determine neurologic pathologies May demonstrate unidentified bright objects in brain scans May demonstrate optic nerve and optic chiasma involvement Bilateral acoustic neuroma is noted in neurofibromatosis type 2 PET - FDG Used to determine staging	Marfanoid habitus may be noted in neurfibromatosis type 1
	Osteoblastoma^[120]^[121]^[122]	Chronic	Weeks to years	Dul aching	Variable	-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings are noted	Radiography May demonstrate a well-circumscribed radiolucent tumor in cortex Thin shell of peripheral new bone distinct from soft tissue > 2cm in diameter No associated reactive zone CT and MRI May demonstrate size and extent of tumor relative to surrounding soft tissue Bone scan Demonstrates cortical activity within the bone Angiography Demonstrates the vascularity of the tumor	Presents in third decade of life Pain is not relieved by NSAIDs
	Osteoid osteoma^[123]^[124]^[120]	Chronic	Years	Dull aching	Variable	-	-	-	-	-	-	-	-	-	-	-	-	-	Serum chemistry study High levels of prostaglandin metabolites have been linked with osteoid osteomas	Radiography May demonstrate sclerosis around a radiolucent nidus CT Demonstrates the margins of the nidus and calcifications present MRI Useful only in a non-calcified nidus Radionuclide scan Demonstrates increased uptake in diseased bone Arteriography Used a last resort when other imaging has been unfruitful Demonstrates 2 phases, early arterial phase, late arterial phase and venous phase	Pain is relieved by use of NSAIDs
	Osteosarcoma^[125]^[126]^[127]^[128]	Chronic	Weeks to years	Severe, sharp	Variable	-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings Elevated LDH and alkaline phosphatase may suggest pulmonary metastasis	Radiography May demonstrate an osteolytic or osteoblastic lesion Elevation of the periosteum may be noted, and is known as "Codman's triangle" Tumor spread to periosteum is known as "sunburst" sign CT Chest CT is done to rule out pulmonary involvement May also demonstrate the margins and extent of tumor MRI Useful in detection of soft tissue involvement Bone scan Increased uptake is noted in regions of metastasis Technetium-99 - methylene diphosphonate is usually used	Cardiac function should be assessed before the use of doxorubicin or daunorubicin
	Prostate cancer^[129]^[130]	Chronic	Months to years	Severe, sharp	Lower abdomen, hips, groin and legs	-	+/-	+/-	-	-	-	+/-	-	-	-	-	+/-	-	PSA Detection is helpful in diagnosis, usually > 10 ng/ml Acid and alkaline phosphatase Useful in detecting metastasis Serurm creatinine and LFT Useful in detecting metasstasis Urine analysis May detect hematuria or infection	Ultrasound Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity MRI May be used to guide biopsy	PSA and DRE are gold standard for screening
Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Muscle-related	Abnormal posturing^[131]^[132]^[133]^[134]	Chronic	Years	Dull aching	Shoulders, arms, hips, legs	+/-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings	Typically no routine imaging done, diagnosed clinically	Back brace maybe used with gentle exercise
	Muscle spasm^[135]^[136]	Acute	Days, weeks, months	Aching	Variable	-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings	MRI and ultrasound May be utilized in non-resolution of muscle spasm to visualize the soft tissue	Rest, bandaging and topical analgesics are often used to treat
	Pyriformis syndrome^[137]^[138]	Chronic	Years	Aching	Hips and legs	+/-	-	-	-	-	-	-	-	-	-	-	-	-	Typically no specific lab findings	MRI and ultrasound May be utilized in non-resolution of muscle spasm to visualize the soft tissue	Rest, bandaging and topical analgesics are often used to treat
Classification of pain in the back based on etiology	Diease	Clinical Manifestation																	Diagnosis		Comments
		Symptoms											Signs						Lab findings	Imaging
		Onset	Duration	Quality of pain	Radiation	Stiffness	Fever	Rigors and chills	Headache	Nausea and vomiting	Syncopy	Weight loss	Motor weakness	Sensory deficit	Pulse Deficit	Heart Murmur	Bowel or bladder dysfunction	Horner's syndrome	Lab findings	Imaging
Miscellaneous	Chronic fatigue syndrome^[139]^[140]^[141]	Chronic	Years	Dull aching	Variable	+/-	-	-	+/-	+/-	-	-	-	-	-	-	-	-	Typically no specific lab findings, however, serology may be somewhat specific and demonstrate; Elevated IgM and/or IgG in coxsackie virus B titer Elevated IgM and/or IgG human herpes virus 6 titer Elevated IgM/IgG in C pneumoniae titer Decrease in natural killer cell percentage or activity Labs used to exclude other pathologies include; CBC May demonstrate leukopenia or leukocytosis LFT May demonstrate elevated serum transaminases, alkaline phosphatase, or lactic dehydrogenase TFT To rule out hypo/hyperthyroidism ESR Usually low Serum electrolytes Hypokalemia or hypocalcemia may be noted ANA May indicate an autoimmune disease Cortisol May indicate pathology of the adrenal gland Serum protein electrophoresis To rule out myeloma or lymphoma	CT and MRI Used to exclude other pathologies PET May demonstrate hypoperfusion of the frontoparietal and/or temporal region of the brain	Usually diagnosed by exclusion
	Depression^[142]^[143]^[143]	Chronic	Months to years	Severe to mild aching	Variable	+/-	-	-	+/-	+/-	+/-	+/-	-	-	-	-	-	-	Typically no specific lab findings Lab testing is used to diagnose organic causes and include; CBC TFT Vitamin B-12 detection Rapid plasma reagin HIV testing Electrolytes, especially calcium, phosphate, and magnesium levels BUN and creatinine LFTs Blood alcohol level Blood and urine toxicology screen ABG Dexamethasone suppression test Cosyntropin stimulation test	CT and MRI To rule out organic brain syndrome or hypopituitarism PET Allows for study of ligand-receptor binding SPECT May demonstrate regional blood flow deficits in the left anterofrontal and temporal regions	Must assess suicidal ideation
	Dysmenorrhea^[144]^[145]	Acute	3 - 7 days	Burning, dull aching or severe	Groin, hips, legs	-	-	-	+/-	+/-	-	-	-	-	-	-	-	-	Typically no specific lab findings Lab tests are done to rule out organic causes, and include; CBC Infection (leukocytosis) or malignancy STD panel Gonorrhea, chlamydia, and PID Beta - Human chorionic gonadotropin Elevated in pregnancy ESR Elevated in subacute salpingitis Urine analysis To rule out urinary tract infection Stool guaiac test To rule out gastrointestinal bleeding	Ultrasound May reveal endometriosis as complex mass with specks Ectopic pregnancy Ovarian cysts Fibroids Intrauterine contraceptive device Hysterosalpingography May demonstrate endometrial polyps Leiomyomas Congenital abnormalities of the uterus IVP May demonstrate a uterine malformation CT May demonstrate ovarian torsion MRI May detect adenomyosis Submucous myomas	Laparoscopy, hysteroscopy, and dilatation and curettage are useful in diagnosis and therapy
	Herpes zoster^[146]^[147]^[148]	Acute or chronic	Variable	Severe, stabbing, electric-like	Dermatomal	-	+/-	+/-	+/-	+/-	+/-	+/-	-	+/-	-	-	-	-	Tzanck smear May demonstrate multinucleated giant cells Direct fluorescent antibody test and/or PCR Allows for differentiation between HSV and VZV	Typically no routine imaging MRI Used to exclude myelopathy or encephalopathy Lumbar puncture and cerebrospinal fluid analysis In cases of suspected meningitis, increased protein and pleocytosis will be noted
	Pregnancy^[149]^[150]^[151]^[152]^[153]	Chronic	Pregnancy term	Dull aching	Groin, hips, legs	+/-	-	-	-	-	-	-	-	-	-	-	-	-	Beta - human chorionic gonadotropin If detected usually confirms pregnancy	Typically no routine imaging is done to prevent radiation exposure, unless complication occurs an MRI may be carried out
	Sickle cell anemia^[154]^[155]^[156]	Acute or chronic	Variable	Severe, sharp	Variable	+/-	+	+/-	-	-	-	-	-	-	-	-	-	-	CBC Hemoglobin level is between 5-9 g/dl Hematocrit is decreased to 17-29% Leukocytosis with predominance of neutrophils Thrombocytopenia ESR Decreased Reticulocyte count Elevated Peripheral blood smear May demonstrate target cells, elongated cells, and sickle erythrocytes Howell - Jolly bodies in an asplenic patient Hemoglobin solubility Distinguishes between sickle cell disease and sickle cell trait Hemoglobin F Percentage of Hemoglobin F is elevated LFT, renal function test and pulmonary function test To assess organ distress or failure ABG To detect oxygen saturation Urine analysis May determine an urinary tract infection with hematuria and isosthenuria Sickling test As screening for sickle hemoglobinopathies Secretory phospholipase A2 May be increased in acute chest syndrome, a complication of sickle cell disease	Radiography Osteonecrosis Dactylitis indicated by medullary expansion, cortical thinning, trabecular resorption, and bone lucency Osteomyelitis may be present and demonstrate sequestra, cortical destruction, periosteal growth and sinus formation MRI and CT In addition to findings in radiography, may detect bone marrow hyperplasia May also be useful in ruling out renal medullary carcinoma in those presenting with hematuria Nuclear imaging Used to detect early osteonecrosis through Technetium-99m bone scanning Used to detect early osteomyelitis through detection of elevation ofwhite blood cells in Indium-11 white blood cell scanning Transcranial doppler ultrasonography Abnormally high blood flow is detected in those at increased risk of stroke Abdominal ultrasound Used to exclude other pathologies such as, cholecystitis, cholelithiasis, ectopic pregnancy, nephrolithiasis, and papillary necrosis May also be used to asses the size of the liver and spleen Echocardiography Used to diagnose pulmonary hypertension based on tricuspid regurgitant jet velocity Also used to assess abnormalities of systolic and diastolic function	Sickle cell trait confers some protection against malaria
	Syringomyelia^[157]^[158]^[159]	Chronic	Years	Dull aching	Variable	+/-	+/-	-	+/-	+/-	-	-	-	-	-	-	-	-	*Typically no specific lab findings	MRI Of choice and demonstrates a syrinx (spinal cord cyst) May also be useful in assessment of CSF flow dynamics Radiography and CT May also visualize a syrinx Gadolinium scan Useful in assessment of post-operative patients and can distinguish between a tumor, scar, and disk material Myelography Used when MRI is unfruitful, and may detect widening of spinal cord and complete subarachnoid block
	Trauma^[160]	Acute or chronic	Variable	Severe, sharp to dull aching	Variable	+/-	-	-	-	+/-	+/-	-	+/-	+/-	-	-	+/-	+/-	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
	Ureteropelvic junction obstruction (UPJ)^[161]^[162]^[163]	Acute	Hours to days	Dull aching	Groin, hips, legs	-	+/-	+/-	+/-	+/-	-	-	-	-	-	-	+/-	-	CBC To rule out anemia Coagulation profile To rule out bleeding Electrolyte levels To rule out nephrolithiasis BUN and serum creatinine To assess kidney function Urine culture To rule out urinary tract infection	Voiding cystourethrography May demonstrate vesicoureteral reflux Ostruction usually shows hydronephrosis without reflux Renal ultrasonography May determine kidney malformation and scarring Dilation of collecting system Annular stricturing IVP May demonstrate a hydronephrotic kidney Used to map out entire urinary system CT and MRU Provides detail about the urinary system such as; Renal vasculature Renal pelvis anatomy Location of crossing vessels Renal cortical scarring Ureteral fetal folds in the proximal ureter Doppler Used to detect cross vessels associated with obstruction MRA May demonstrate aberrant renal vessels	Congenital abrnormalities in both children and adults are usually the cause of UPJ obstruction

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Back pain}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Back_pain]]
 {{CMG}};{{AE}}{{HM}}
@@ Line 7: / Line 7: @@
 ==Overview==
-There are several life-threatening causes of back pain which need to be evaluated for first, which include; spinal cord or cauda equina compression, aortic dissection, aortic aneurysm, vertebral osteomyelitis, epidural abscess, and metastatic cancer. The other possible causes of back pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.
+There are several life-threatening causes of [[back]] [[pain]], including [[spinal cord]] or [[cauda equina compression]], [[aortic dissection]], [[aortic aneurysm]], vertebral [[osteomyelitis]], epidural [[abscess]], and [[metastatic cancer]]. These should be evaluated alongside other possible causes of [[back]] [[pain]] by carefully assessing the nature of the [[pain]], and obtaining a thorough [[patient]] history.
-==Differential Diagnosis==
+==Differential Diagnosis of Back Pain==
+'''The following table outlines the major differential diagnoses of back pain.'''
+'''''To review the differential diagnosis of back pain and bowel or bladder dysfunction, [[Back pain and bowel or bladder dysfunction|click here]]'''.''
+'''''To review the differential diagnosis of back pain, bowel or bladder dysfunction and horner's syndrome, [[Back pain, bowel or bladder dysfunction and horner's syndrome|click here]]'''.''
+'''''To review the differential diagnosis of back pain and fever, [[Back pain and fever|click here]]'''.''
+'''''To review the differential diagnosis of back pain, fever and stiffness, [[Back pain, fever and stiffness|click here]]'''.''
+'''''To review the differential diagnosis of back pain and heart murmur, [[Back pain and heart murmur|click here]]'''.''
+'''''To review the differential diagnosis of back pain and headache, [[Back pain and headache|click here]]'''.''
+'''''To review the differential diagnosis of back pain and horner's syndrome, [[Back pain and horner's syndrome|click here]]'''.''
+'''''To review the differential diagnosis of back pain and motor weakness, [[Back pain and motor weakness|click here]]'''.''
+'''''To review the differential diagnosis of back pain, motor weakness and sensory deficit, [[Back pain, motor weakness and sensory deficit|click here]]'''.''
+'''''To review the differential diagnosis of back pain and nausea and vomiting, [[Back pain and nausea and vomiting|click here]]'''.''
+'''''To review the differential diagnosis of back pain and pulse deficit, [[Back pain and pulse deficit|click here]]'''.''
+'''''To review the differential diagnosis of back pain and sensory deficit, [[Back pain and sensory deficit|click here]]'''.''
+'''''To review the differential diagnosis of back pain and stiffness, [[Back pain and stiffness|click here]]'''.''
+'''''To review the differential diagnosis of back pain and syncopy, [[Back pain and syncopy|click here]]'''.''
-===Life Threatening Causes===
+'''''To review the differential diagnosis of back pain and weight loss, [[Back pain and weight loss|click here]]'''.''
-Life threatening diseases to exclude immediately include:<ref name="pmid21282698">{{cite journal |vauthors=Chou R, Qaseem A, Owens DK, Shekelle P |title=Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians |journal=Ann. Intern. Med. |volume=154 |issue=3 |pages=181–9 |date=February 2011 |pmid=21282698 |doi=10.7326/0003-4819-154-3-201102010-00008 |url=}}</ref><ref name="pmid9270576">{{cite journal |vauthors=Schiff D, O'Neill BP, Suman VJ |title=Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach |journal=Neurology |volume=49 |issue=2 |pages=452–6 |date=August 1997 |pmid=9270576 |doi= |url=}}</ref><ref name="pmid2967893">{{cite journal |vauthors=Deyo RA, Diehl AK |title=Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies |journal=J Gen Intern Med |volume=3 |issue=3 |pages=230–8 |date=1988 |pmid=2967893 |doi= |url=}}</ref><ref name="pmid24150427">{{cite journal |vauthors=Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS |title=Assessment of cauda equina syndrome progression pattern to improve diagnosis |journal=Spine |volume=39 |issue=7 |pages=596–602 |date=April 2014 |pmid=24150427 |doi=10.1097/BRS.0000000000000079 |url=}}</ref><ref name="pmid9270576">{{cite journal |vauthors=Schiff D, O'Neill BP, Suman VJ |title=Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach |journal=Neurology |volume=49 |issue=2 |pages=452–6 |date=August 1997 |pmid=9270576 |doi= |url=}}</ref><ref name="pmid2967893">{{cite journal |vauthors=Deyo RA, Diehl AK |title=Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies |journal=J Gen Intern Med |volume=3 |issue=3 |pages=230–8 |date=1988 |pmid=2967893 |doi= |url=}}</ref><ref name="pmid12353946">{{cite journal |vauthors=Jarvik JG, Deyo RA |title=Diagnostic evaluation of low back pain with emphasis on imaging |journal=Ann. Intern. Med. |volume=137 |issue=7 |pages=586–97 |date=October 2002 |pmid=12353946 |doi= |url=}}</ref><ref name="pmid8542211">{{cite journal |vauthors=Underwood MR, Dawes P |title=Inflammatory back pain in primary care |journal=Br. J. Rheumatol. |volume=34 |issue=11 |pages=1074–7 |date=November 1995 |pmid=8542211 |doi= |url=}}</ref><ref name="pmid7987418">{{cite journal |vauthors= |title=Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research |journal=Clin Pract Guidel Quick Ref Guide Clin |volume= |issue=14 |pages=iii–iv, 1–25 |date=December 1994 |pmid=7987418 |doi= |url=}}</ref><ref name="pmid25806916">{{cite journal |vauthors=Ropper AH, Zafonte RD |title=Sciatica |journal=N. Engl. J. Med. |volume=372 |issue=13 |pages=1240–8 |date=March 2015 |pmid=25806916 |doi=10.1056/NEJMra1410151 |url=}}</ref><ref name="pmid25844995">{{cite journal |vauthors=Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC |title=Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial |journal=Ann. Intern. Med. |volume=162 |issue=7 |pages=465–73 |date=April 2015 |pmid=25844995 |doi=10.7326/M14-1420 |url=}}</ref><ref name="pmid15062719">{{cite journal |vauthors=Papadopoulos EC, Khan SN |title=Piriformis syndrome and low back pain: a new classification and review of the literature |journal=Orthop. Clin. North Am. |volume=35 |issue=1 |pages=65–71 |date=January 2004 |pmid=15062719 |doi=10.1016/S0030-5898(03)00105-6 |url=}}</ref><ref name="pmid20596735">{{cite journal |vauthors=Hopayian K, Song F, Riera R, Sambandan S |title=The clinical features of the piriformis syndrome: a systematic review |journal=Eur Spine J |volume=19 |issue=12 |pages=2095–109 |date=December 2010 |pmid=20596735 |pmc=2997212 |doi=10.1007/s00586-010-1504-9 |url=}}</ref><ref name="pmid2932746">{{cite journal |vauthors=Potter NA, Rothstein JM |title=Intertester reliability for selected clinical tests of the sacroiliac joint |journal=Phys Ther |volume=65 |issue=11 |pages=1671–5 |date=November 1985 |pmid=2932746 |doi= |url=}}</ref><ref name="pmid7326071">{{cite journal |vauthors=Russel AS, Maksymowych W, LeClercq S |title=Clinical examination of the sacroiliac joints: a prospective study |journal=Arthritis Rheum. |volume=24 |issue=12 |pages=1575–7 |date=December 1981 |pmid=7326071 |doi= |url=}}</ref><ref name="pmid10534797">{{cite journal |vauthors=Levangie PK |title=Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain |journal=Phys Ther |volume=79 |issue=11 |pages=1043–57 |date=November 1999 |pmid=10534797 |doi= |url=}}</ref><ref name="pmid12147007">{{cite journal |vauthors=Riddle DL, Freburger JK |title=Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study |journal=Phys Ther |volume=82 |issue=8 |pages=772–81 |date=August 2002 |pmid=12147007 |doi= |url=}}</ref><ref name="pmid17304687">{{cite journal |vauthors=Irwin RW, Watson T, Minick RP, Ambrosius WT |title=Age, body mass index, and gender differences in sacroiliac joint pathology |journal=Am J Phys Med Rehabil |volume=86 |issue=1 |pages=37–44 |date=January 2007 |pmid=17304687 |doi= |url=}}</ref><ref name="pmid26484005">{{cite journal |vauthors=Jancuska JM, Spivak JM, Bendo JA |title=A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome |journal=Int J Spine Surg |volume=9 |issue= |pages=42 |date=2015 |pmid=26484005 |pmc=4603258 |doi=10.14444/2042 |url=}}</ref>
-*[[Abdominal aortic aneurysm]]
-*[[Adrenal hemorrhage]]
-*[[Aortic dissection]]
-*[[Arachnoiditis]]
-*[[Cauda equina syndrome]]
-*[[Cervical fracture]]
-*[[Chronic stable angina]]
-*[[Epidural abscess]]
-*[[Pulmonary embolism]]
-*[[Retroperitoneal hematoma]]
-*[[Traumatic aortic rupture]]
-*[[Vertebral fractures]]
-===Common Causes===
+'''''To review the differential diagnosis of back pain exhibiting "red flags", [[Back pain red flags|click here]]'''.''
-* [[Abnormal posturing]]
-* [[Degenerative disc disease]]
-* [[Depression]]
-* [[Osteoarthritis]]
-* [[Pregnancy]]
-* [[Premenstrual syndrome]]
-* [[Sciatica]]
-* [[Spinal disc herniation]]
-* [[Spinal stenosis]]
-* [[Trauma]]
-==Differential Diagnosis of Back Pain==
+'''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]]
+<small><small>
 {| class="wikitable"
 ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
@@ Line 55: / Line 63: @@
 ! 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
@@ Line 71: / Line 79: @@
 ! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
 |-
-! rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" |Vascular
+! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Vascular
-![[Aortic dissection]]<ref name="pmid20717014">{{cite journal |vauthors=Suzuki T, Distante A, Eagle K |title=Biomarker-assisted diagnosis of acute aortic dissection: how far we have come and what to expect |journal=Curr. Opin. Cardiol. |volume=25 |issue=6 |pages=541–5 |date=November 2010 |pmid=20717014 |doi=10.1097/HCO.0b013e32833e6e13 |url=}}</ref><ref name="pmid29146682">{{cite journal |vauthors=Wang Y, Tan X, Gao H, Yuan H, Hu R, Jia L, Zhu J, Sun L, Zhang H, Huang L, Zhao D, Gao P, Du J |title=Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection |journal=Circulation |volume=137 |issue=3 |pages=259–269 |date=January 2018 |pmid=29146682 |doi=10.1161/CIRCULATIONAHA.117.030469 |url=}}</ref><ref name="pmid27666178">{{cite journal |vauthors=Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W |title=Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=118 |issue=9 |pages=1405–1409 |date=November 2016 |pmid=27666178 |doi=10.1016/j.amjcard.2016.07.052 |url=}}</ref><ref name="pmid27666178">{{cite journal |vauthors=Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W |title=Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=118 |issue=9 |pages=1405–1409 |date=November 2016 |pmid=27666178 |doi=10.1016/j.amjcard.2016.07.052 |url=}}</ref><ref name="pmid11015167">{{cite journal |vauthors=Suzuki T, Katoh H, Tsuchio Y, Hasegawa A, Kurabayashi M, Ohira A, Hiramori K, Sakomura Y, Kasanuki H, Hori S, Aikawa N, Abe S, Tei C, Nakagawa Y, Nobuyoshi M, Misu K, Sumiyoshi T, Nagai R |title=Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study |journal=Ann. Intern. Med. |volume=133 |issue=7 |pages=537–41 |date=October 2000 |pmid=11015167 |doi= |url=}}</ref><ref name="pmid24036495">{{cite journal |vauthors=Marshall LM, Carlson EJ, O'Malley J, Snyder CK, Charbonneau NL, Hayflick SJ, Coselli JS, Lemaire SA, Sakai LY |title=Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation |journal=Circ. Res. |volume=113 |issue=10 |pages=1159–68 |date=October 2013 |pmid=24036495 |doi=10.1161/CIRCRESAHA.113.301498 |url=}}</ref>
+![[Retroperitoneal hematoma]]<ref name="pmid25744173">{{cite journal |vauthors=Poplin GS, McMurry TL, Forman JL, Hartka T, Park G, Shaw G, Shin J, Kim Hj, Crandall J |title=Nature and etiology of hollow-organ abdominal injuries in frontal crashes |journal=Accid Anal Prev |volume=78 |issue= |pages=51–7 |date=May 2015 |pmid=25744173 |doi=10.1016/j.aap.2015.02.015 |url=}}</ref><ref name="pmid16508495">{{cite journal |vauthors=Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H |title=American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries |journal=J Trauma |volume=60 |issue=2 |pages=351–6 |date=February 2006 |pmid=16508495 |doi=10.1097/01.ta.0000202509.32188.72 |url=}}</ref><ref name="pmid23790766">{{cite journal |vauthors=Harris DG, Drucker CB, Brenner ML, Sarkar R, Narayan M, Crawford RS |title=Patterns and management of blunt abdominal aortic injury |journal=Ann Vasc Surg |volume=27 |issue=8 |pages=1074–80 |date=November 2013 |pmid=23790766 |doi=10.1016/j.avsg.2012.09.019 |url=}}</ref>
-|Severe and sudden (acute) and rarely, chronic
+|[[Acute]] or [[subacute]]
 |Minutes to hours
 |Sharp and knife-like, also tearing or ripping
 |Back and/or flanks
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-| -
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 86: / Line 93: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|Elevations in:
+|<nowiki>-</nowiki>
-* D - dimer
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|
+Typically no specific lab findings, however, evidence of [[hemorrhage]] and organ injury may be seen in:
+*[[Complete blood count]]; [[normochromic normocytic anemia]] seen in [[hemorrhage]]
+*Elevated serum [[electrolytes]]
+*Elevated [[liver function tests]]
+*Elevated [[amylase]] or [[lipase]]
+|[[CT]] with IV contrast
-* Smooth muscle myosin heavy chain
+*May show venous delay and indicate renal trauma
-* Soluble ST2
-* Soluble elastin fragments
+[[Cystography]]
-* High -sensitivity C-reactive protein
-* Fibrinogen
+*Should be considered in evaluation of [[hematuria]] and pelvic injury
-* Fibrillin fragments
-|ECG:
-* Normal
-* Non - specific ST wave changes
-* Hypertrophy patterns
-* ST segment elevation indicating myocardial infarction
-Chest radiography:
-* Normal
-* Mediastinal or aortic widening
 |
-* Increased risk of occurence with Marfan syndrome
+*Mostly caused by automobile accidents
 |-
-![[Aortic aneurysm]]
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
-rupture<ref name="pmid19786250">{{cite journal |vauthors=Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ |title=The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines |journal=J. Vasc. Surg. |volume=50 |issue=4 Suppl |pages=S2–49 |date=October 2009 |pmid=19786250 |doi=10.1016/j.jvs.2009.07.002 |url=}}</ref><ref name="pmid2359191">{{cite journal |vauthors=Sullivan CA, Rohrer MJ, Cutler BS |title=Clinical management of the symptomatic but unruptured abdominal aortic aneurysm |journal=J. Vasc. Surg. |volume=11 |issue=6 |pages=799–803 |date=June 1990 |pmid=2359191 |doi= |url=}}</ref><ref name="pmid18394857">{{cite journal |vauthors=Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ |title=Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective |journal=J. Vasc. Surg. |volume=47 |issue=6 |pages=1165–70; discussion 1170–1 |date=June 2008 |pmid=18394857 |doi=10.1016/j.jvs.2008.01.055 |url=}}</ref>
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
-- [[Abdominal aortic aneurysm]]
+! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
+! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
-- [[Thoracic aortic aneurysm]]
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
-|Acute
+|-
-|Minutes to hours
+! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
-|Sharp and knife-like, also tearing or ripping
+! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
-|Back and/ or flanks
+! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
-|<nowiki>-</nowiki>
+! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
-| -
+|-
-|<nowiki>-</nowiki>
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
-|<nowiki>-</nowiki>
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
-|<nowiki>-</nowiki>
+! 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="6" 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>
 |<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
 |
-Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
+*Usually caused by [[meningitis]] or [[TB]]
-* Complete blood count; normochromic normocytic anemia seen in haemorrhage
-* Elevated serum electrolytes
-* Elevated liver function tests
-* Elevated amylase or lipase
-|Ultrasonography
-* Visualization of aneurysm, size and/or rupture and hematoma
-Chest radiography
-* Visualizes calcifications in aneurysm but not specific
-CT
-* Demonstrates aortic size, extent, and involvement of organ arteries
-MRI
-* Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT
-Angiography
-* Allows 3D construction of aorta
-Echocardiography (Transesophageal)
-* Demonstrates fluid shift and need for cardiology intervention
-|
-* Livedo reticularis may be seen and indicates thrombotic phenomenon
 |-
-![[Chronic stable angina]]<ref name="pmid17197405">{{cite journal |vauthors=Kreiner M, Okeson JP, Michelis V, Lujambio M, Isberg A |title=Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study |journal=J Am Dent Assoc |volume=138 |issue=1 |pages=74–9 |date=January 2007 |pmid=17197405 |doi= |url=}}</ref><ref name="pmid3970650">{{cite journal |vauthors=Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L |title=Acute chest pain in the emergency room. Identification and examination of low-risk patients |journal=Arch. Intern. Med. |volume=145 |issue=1 |pages=65–9 |date=January 1985 |pmid=3970650 |doi= |url=}}</ref>
+![[Cauda equina syndrome]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref>
-|Chronic
+|Acute
-|Variable
+|Hours
-|Discomfort in the chest
+|Severe, sharp local pain
-|Left shoulder, arm and jaw
+|Rarely to sacroiliac joint
+|<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>
 |<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
-| -
+|CBC
-|Detection of:
-* Urinary proton nuclear magnetic resonance spectroscopy
+*To rule out [[anemia]]
+[[Electrolytes]], [[blood urea nitrogen]], and [[creatinine]]
+*To rule out [[renal failure]] and [[retroperitoneal hematoma]]
+[[Erythrocyte sedimentation rate]]
+*To rule out inflammatory origin
+[[Syphilis]] serology
+*To rule out meningovascular syphilis
+|Radiography
-* Toll-like receptors 2 and 4 (TLR-2 and TLR-4)  on platelets
+*May show vertebral erosions
-|Chest radiography
-* Normal, may show calcification or complications such as pleural effusion
+MRI
-Exercise stress testing
-* Establishes diagnosis and extent of angina
+*Of choice and may show nerve root abnormalities
-Stress Echo
-* To evaluate wall motion, normal in stable angina
+Duplex
-Nuclear imaging
-* To assess myocardial perfusion, reduced in stable angina
+*For vascular abnormalities
-CT
-* To evaluate coronary artery calcium (cac) which may or may not be elevated
+[[Lumbar puncture]]
-CT Angiography
-* To evaluate stenosis, <70% in stable angina
+*For inflammation
-EKG
+|Electrical studies:
-* Normal in stable angina
-|
+[[EMG]]
-* Hallmark is relief by rest or sublingual nitroglycerin
-|-
+*Done to rule out acute denervation
-![[Pulmonary embolism]]<ref name="pmid25377011">{{cite journal |vauthors=Lassila R, Jula A, Pitkäniemi J, Haukka J |title=The association of statin use with reduced incidence of venous thromboembolism: a population-based cohort study |journal=BMJ Open |volume=4 |issue=11 |pages=e005862 |date=November 2014 |pmid=25377011 |pmc=4225235 |doi=10.1136/bmjopen-2014-005862 |url=}}</ref><ref name="pmid12885687">{{cite journal |vauthors=Horlander KT, Mannino DM, Leeper KV |title=Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data |journal=Arch. Intern. Med. |volume=163 |issue=14 |pages=1711–7 |date=July 2003 |pmid=12885687 |doi=10.1001/archinte.163.14.1711 |url=}}</ref>
+SSEPs
+*Done to rule out [[multiple sclerosis]]
+|-
+![[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
-|Minutes
+|Variable
-|Sharp
+|Dull, throbbing pain
-|All over chest and back
+|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>
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
+|[[CBC]]
-|<nowiki>-</nowiki>
+*May show [[leukocytosis]], left shift, [[thrombocytopenia]], and [[anemia]]
-|Lab findings are not specfic and are done to rule out other diseases such as:
-** Antithrombin III deficiency
+ESR
-** Protein C or protein S deficiency
-** Lupus
+*Elevated
-** Homocystinuria
-** Malignancy
+Culture and sensitivity
-** Connective tissue disorders
-|
+*To identify causative organism
-* D - dimer is positive and ventilation- perfusion scanning will show a a perfusion/ventilation mismatch
-* CT Angiography and duplex angiography are able to visualize the embolism
+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
 |
-* PE may occur even in patients that are fully anticoagulated
+*LP carries risk of spread of infection
-* DVT is a common source
 |-
-![[Traumatic aortic rupture]]<ref name="pmid10780601">{{cite journal |vauthors=Dyer DS, Moore EE, Ilke DN, McIntyre RC, Bernstein SM, Durham JD, Mestek MF, Heinig MJ, Russ PD, Symonds DL, Honigman B, Kumpe DA, Roe EJ, Eule J |title=Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients |journal=J Trauma |volume=48 |issue=4 |pages=673–82; discussion 682–3 |date=April 2000 |pmid=10780601 |doi= |url=}}</ref><ref name="pmid9820704">{{cite journal |vauthors=Mirvis SE, Shanmuganathan K, Buell J, Rodriguez A |title=Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury |journal=J Trauma |volume=45 |issue=5 |pages=922–30 |date=November 1998 |pmid=9820704 |doi= |url=}}</ref>
+![[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
-|Minutes to hours
+|Variable
-|Sharp and knife-like, also tearing or ripping
+|Severe, shooting pain
-|Back and/ or flanks
+|Anterior thigh and knee
+| +/-
 |<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, however, evidence of haemorrhage and organ injury may be seen in:
-* Complete blood count; normochromic normocytic anemia seen in haemorrhage
-* Elevated serum electrolytes
-* Elevated liver function tests
-* Elevated amylase or lipase
 |
-Ultrasonography
+*Typically no specific lab findings
-* Visualization of rupture, size and hematoma
+|
+Radiography
+*To rule out serious underlying etiology
 CT
-* Demonstrates intimal flap, hematoma, filling defect, aortic contour abnormality, pseudoaneurysm, vessel wall disruption,  and extravasation of intravenous contrast
+*Demonstrates [[disc herniation]]
 MRI
-* Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT
-Angiography
+*Demonstrates [[disc herniation]] and nerve root impingement
-* Allows 3D construction of aorta
-Echocardiography (Transesophageal)
+Myelography
-* Demonstrates fluid shift and need for cardiology intervention
+*Used preoperatively to visualize spinal anatomy accurately
+Discography
+*To localize a symptomatic disc
 |
-* Mostly caused by automobile accidents
+*[[Disc herniation]] is the most common cause of nerve impingement
 |-
-![[Retroperitoneal hematoma]]<ref name="pmid25744173">{{cite journal |vauthors=Poplin GS, McMurry TL, Forman JL, Hartka T, Park G, Shaw G, Shin J, Kim Hj, Crandall J |title=Nature and etiology of hollow-organ abdominal injuries in frontal crashes |journal=Accid Anal Prev |volume=78 |issue= |pages=51–7 |date=May 2015 |pmid=25744173 |doi=10.1016/j.aap.2015.02.015 |url=}}</ref><ref name="pmid16508495">{{cite journal |vauthors=Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H |title=American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries |journal=J Trauma |volume=60 |issue=2 |pages=351–6 |date=February 2006 |pmid=16508495 |doi=10.1097/01.ta.0000202509.32188.72 |url=}}</ref><ref name="pmid23790766">{{cite journal |vauthors=Harris DG, Drucker CB, Brenner ML, Sarkar R, Narayan M, Crawford RS |title=Patterns and management of blunt abdominal aortic injury |journal=Ann Vasc Surg |volume=27 |issue=8 |pages=1074–80 |date=November 2013 |pmid=23790766 |doi=10.1016/j.avsg.2012.09.019 |url=}}</ref>
+![[Sciatica]]<ref name="pmid967084">{{cite journal |vauthors=Hay MC |title=Anatomy of the lumbar spine |journal=Med. J. Aust. |volume=1 |issue=23 |pages=874–6 |date=June 1976 |pmid=967084 |doi= |url=}}</ref><ref name="pmid9971865">{{cite journal |vauthors=Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA |title=Lack of effectiveness of bed rest for sciatica |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=418–23 |date=February 1999 |pmid=9971865 |doi=10.1056/NEJM199902113400602 |url=}}</ref><ref name="pmid9971865">{{cite journal |vauthors=Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA |title=Lack of effectiveness of bed rest for sciatica |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=418–23 |date=February 1999 |pmid=9971865 |doi=10.1056/NEJM199902113400602 |url=}}</ref>
-|Acute or subacute
+|Acute
 |Minutes to hours
-|Sharp and knife-like, also tearing or ripping
+|Severe, shooting pain
-|Back and/or flanks
+|Posterior thigh, buttocks and knee
+| +/-
 |<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 276: / Line 349: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
+|To exclude other pathologies
+*[[CBC]] with differential
+*[[ESR]]
+*Alkaline and acid phosphatase level
+*Serum [[calcium]] level
+*Serum [[protein]] electrophoresis
 |
-Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
+Radiography
-* Complete blood count; normochromic normocytic anemia seen in haemorrhage
-* Elevated serum electrolytes
+*With technetium-99m labeled [[phosphorus]] to indicate bone mineralization status
-* Elevated liver function tests
-* Elevated amylase or lipase
+CT
-|CT with IV contrast
-* May show venous delay and indicate renal trauma
+*Demonstrates [[disc herniation]]
-Cystography
-* Should be considered in evaluation of hematuria and pelvic injury
+MRI
+*Demonstrates [[disc herniation]] and nerve root impingement
+Myelography
+*Used preoperatively to visualize spinal anatomy accurately
+Discography
+*To localize a symptomatic disc
 |
-* Mostly caused by automobile accidents
+*May have a psychological component
 |-
-![[Adrenal hemorrhage|Waterhouse-Friderichsen syndrome]]<ref name="pmid5006579">{{cite journal |vauthors=Migeon CJ, Kenny FM, Hung W, Voorhess ML |title=Study of adrenal function in children with meningitis |journal=Pediatrics |volume=40 |issue=2 |pages=163–83 |date=August 1967 |pmid=5006579 |doi= |url=}}</ref><ref name="pmid13932989">{{cite journal |vauthors=MARGARETTEN W, NAKAI H, LANDING BH |title=Septicemic adrenal hemorrhage |journal=Am. J. Dis. Child. |volume=105 |issue= |pages=346–51 |date=April 1963 |pmid=13932989 |doi= |url=}}</ref>
+![[Spinal cord compression]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref>
+- Thoracic spine
+- Lumbar spine
 |Acute
 |Minutes to hours
-|Sudden, severe, sharp
+|Severe and localized
-|Back and/or flanks
+|Locally, may radiate below lesion
+|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-| +/-
-| +/-
-|<nowiki>+/-</nowiki>
-|<nowiki>+/-</nowiki>
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 309: / Line 401: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
-|CBC
+|<nowiki>-</nowiki>
-* May show decreased hemotocrit, leukocytosis and rarely, eosinophilia
+|
-Serum electrolytes
++/-
-* Hyponatremia
+|<nowiki>-</nowiki>
-* Hyperkalemia
+|Neoplasm must be suspected and is ruled out by
-* Hypercalcemia
-Blood urea nitrogen
+**CBC - May demonstrate a [[pancytopenia]]
-* Elevated
+**[[Prothrombin time]] and activated [[partial thromboplastin time]] - May be prolonged
-Creatinine
+**Metabolic profile, including calcium level and liver function - May indicate [[metastasis]]
-* Elevated
+|MRI
-Plasma glucose
-* Hypoglycemia
+*May demonstrate tumors and collapse of intervertebral spaces
-Serum cortisol
+*May distinguish between bone lesions and malignancy
-* Decreased
-Plasma ACTH,
+Radiography
-* Elevated
-|CT
+*May demonstrates bony destruction or [[calcification]]
-* Shows adrenal enlargement or adrenal aymmetry
+Nuclear imaging
+*To identify neoplasms
 |
-* Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis
+*Aggressive radiotherapy is often needed
 |-
 ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
@@ Line 344: / Line 441: @@
 ! 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
@@ Line 360: / Line 457: @@
 ! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
 |-
-! rowspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |NeurologicalU
+! rowspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Bone
-![[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>
+![[Ankylosing spondylitis]]<ref name="pmid20882310">{{cite journal |vauthors=Roussou E, Sultana S |title=Spondyloarthritis in women: differences in disease onset, clinical presentation, and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides |journal=Clin. Rheumatol. |volume=30 |issue=1 |pages=121–7 |date=January 2011 |pmid=20882310 |doi=10.1007/s10067-010-1581-5 |url=}}</ref><ref name="pmid26768406">{{cite journal |vauthors=Deodhar A, Strand V, Kay J, Braun J |title=The term 'non-radiographic axial spondyloarthritis' is much more important to classify than to diagnose patients with axial spondyloarthritis |journal=Ann. Rheum. Dis. |volume=75 |issue=5 |pages=791–4 |date=May 2016 |pmid=26768406 |doi=10.1136/annrheumdis-2015-208852 |url=}}</ref>
-|Acute
+|Subacute or chronic
-|Hours
+|Years
 |Dull aching pain
-|Head, neck and back
+|Local
-| +/-
 |<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
-|-
-![[Cauda equina syndrome]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref>
-|Acute
-|Hours
-|Severe, sharp local pain
-|Rarely to sacroiliac joint
 |<nowiki>-</nowiki>
-| -
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 408: / Line 472: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
-|CBC
+|<nowiki>-</nowiki>
-* To rule out anemia
+|
-Electrolytes, blood urea nitrogen, and creatinine
+*Typically no specific lab findings
-* To rule out renal failure and retroperitoneal hematoma
+|MRI
-Erythrocyte sedimentation rate
-* To rule out inflammatory origin
+*Demonstrates both inflammatory and structural lesions
-Syphilis serology
-* To rule out meningovascular syphilis
+CT
-|Radiography
-* May show vertebral erosions
+*Useful in identifying structural lesions
-MRI
-* Of choice and may show nerve root abnormalities
+Radiography
-Duplex
-* For vascular abnormalities
+*Useful in identifying structural lesions
-Lumbar puncture
-* For inflammation
+Doppler ultrasound
-|Electrical studies:
+*To detect active esthesitis
+|
+Extra-articular manifestations are common and include
+*[[Uveitis]]
+*CVD
+*Respiratory disease
+*Renal disease
+*Neurologic disease
+*GI disease
+*Metabolic bone disease
-EMG
+Often affecting a young male
-* Done to rule out acute denervation
-SSEPs
-* Done to rule out multiple sclerosis
 |-
-![[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>
+![[Bertolotti's syndrome]]<ref name="pmid2096606" /> (Lumbosacral transitional vertebrae)
-|Acute
+|Chronic
-|Variable
+|Years
-|Dull, throbbing pain
+|Dull aching pain
-|Locally
+|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>
 |<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
+*Typically no specific lab findings
 |
+MRI
+*Of choice and demonstrates transitional vertebra
+CT
+*Demonstrates vertebral transition
 Radiography
-* To rule out serious underlying etiology
-CT
+*Demonstrates vertebral transition
-* 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
 |
+*Congenital anomaly and may be asymptomatic
 |-
-![[Sciatica]]
+![[Osteomyelitis|Chronic recurrent focal osteomyelitis]]<ref name="pmid15276398">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=Lancet |volume=364 |issue=9431 |pages=369–79 |date=2004 |pmid=15276398 |doi=10.1016/S0140-6736(04)16727-5 |url=}}</ref><ref name="pmid9431368">{{cite journal |vauthors=Mader JT, Shirtliff M, Calhoun JH |title=Staging and staging application in osteomyelitis |journal=Clin. Infect. Dis. |volume=25 |issue=6 |pages=1303–9 |date=December 1997 |pmid=9431368 |doi= |url=}}</ref><ref name="pmid9077380">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=N. Engl. J. Med. |volume=336 |issue=14 |pages=999–1007 |date=April 1997 |pmid=9077380 |doi=10.1056/NEJM199704033361406 |url=}}</ref>
-|Acute
+|Chronic
-|Minutes to hours
+|Years
-|Severe, shooting pain
+|Dull aching pain
-|Posterior thigh, buttocks and knee
+|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>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>+/-</nowiki>
+|[[CBC]]
-|<nowiki>-</nowiki>
+*[[Leukocytosis]] and left shift
-|To exclude other pathologies
-* CBC with differential
+[[ESR]]
-* ESR
-* Alkaline and acid phosphatase level
+*Elevated
-* Serum calcium level
-* Serum protein electrophoresis
+[[CRP]]
-|
+*Elevated
+[[Procalcitonin]]
+*Elevated
+Culture and sensitivity
+*To identify causative agent
+|Radiography
+*Demonstrates endosteal or medullary lesion
+*Sequestration and cavity formation
+MRI
+*[[Bone marrow]] abnormalities and lytic changes
-Radiography
-* With technetium-99m labeled phosphorus to indicate bone mineralization status
 CT
-* Demonstrates disc herniation
-MRI
+*Articular and periarticular involvement
-* Demonstrates disc herniation and nerve root impingement
-Myelography
+Ultrasound
-* Used preoperatively to visualize spinal anatomy accurately
-Discography
+*Soft tissue abnormalities
-* To localize a symptomatic disc
+Nuclear imaging
+*Loss of [[bone density]]
 |
+*Acute presentation is often seen in children and is associated with gait abnormalities
 |-
-![[Spinal cord compression]]
+![[Cervical fracture]]<ref name="pmid23940857">{{cite journal |vauthors=Nelson DW, Martin MJ, Martin ND, Beekley A |title=Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma |journal=J Trauma Acute Care Surg |volume=75 |issue=1 |pages=135–9 |date=July 2013 |pmid=23940857 |doi= |url=}}</ref><ref name="pmid18783909">{{cite journal |vauthors=Greenbaum J, Walters N, Levy PD |title=An evidenced-based approach to radiographic assessment of cervical spine injuries in the emergency department |journal=J Emerg Med |volume=36 |issue=1 |pages=64–71 |date=January 2009 |pmid=18783909 |doi=10.1016/j.jemermed.2008.01.014 |url=}}</ref>
-- Thoracic spine
-- Lumbar spine
 |Acute
 |Minutes to hours
+|Severe, sharp
+|Shoulder and arm
+|<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
+*May demonstrate [[fracture]] of the vertebrae and/or preexisting pathology that may have lead to [[fracture]]
+CT
+*May show pathology that was not noted on radiography
+MRI
+*May show pathology that was not noted on radiography
 |
+*If suspected should be stablized immediately
+|-
+![[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 disc herniation|Disc herniation]]<ref name="pmid9670842">{{cite journal |vauthors=Hay MC |title=Anatomy of the lumbar spine |journal=Med. J. Aust. |volume=1 |issue=23 |pages=874–6 |date=June 1976 |pmid=967084 |doi= |url=}}</ref><ref name="pmid12152441">{{cite journal |vauthors=Levin KH |title=Electrodiagnostic approach to the patient with suspected radiculopathy |journal=Neurol Clin |volume=20 |issue=2 |pages=397–421, vi |date=May 2002 |pmid=12152441 |doi= |url=}}</ref>
+|Acute
+|Minutes to hours
+|Sharp,shooting
+|Legs and hips
+|<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 the size and location of the herniated disc and surrounding soft tissue
+CT myelography
+*Useful in lateral herniations with [[calcification]]
+Radiography
+*Demonstrates osteophytes, disc-space narrowing, and [[kyphosis]]
+Discography
+*Controversial, may show endplate irregularites or annular tears
 |
-|
+*Often presents with parathesias and no pain
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
+![[Discitis]]<ref name="pmid8235857">{{cite journal |vauthors=Hamanishi C, Tanaka S |title=Dorsal root ganglia in the lumbosacral region observed from the axial views of MRI |journal=Spine |volume=18 |issue=13 |pages=1753–6 |date=October 1993 |pmid=8235857 |doi= |url=}}</ref><ref name="pmid25734175">{{cite journal |vauthors=Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM, Huddleston PM, Nassr A, Mandrekar JM, Berbari EF |title=Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients |journal=Open Forum Infect Dis |volume=1 |issue=3 |pages=ofu107 |date=December 2014 |pmid=25734175 |pmc=4324221 |doi=10.1093/ofid/ofu107 |url=}}</ref>
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
+|Chronic
-! 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="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Bone
-![[Ankylosing spondylitis]]
-|Subacute or chronic
 |Years
+|Dull aching or throbbing
+|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>
+|<nowiki>-</nowiki>
+|[[CBC]]
+*May demonstrate [[leukocytosis]]
+[[ESR]]
+*May be elevated
+[[CRP]]
+*May be elevated
+[[Procalcitonin]]
+*May be elevated
+Culture and sensitivity
+*To identify causative agent
+|[[MRI]]
+*Narrowing of disk space and low signalling indicates [[edema]]
+[[CT]]
+*Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus
+Radiography
+*Disk space narrowing with destruction of endplates and c[[alcification]] of annulus
+Nuclear imaging
+*Focal uptake of gallium-67 and technetium-99m in area of destruction
 |
-|
+*Most likely due to hematogenous spread of organism
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Bertolotti's syndrome]] (Lumbosacral transitional vertebrae)
+!Hyperkyphosis<ref name="pmid4419577">{{cite journal |vauthors=Milne JS, Lauder IJ |title=Age effects in kyphosis and lordosis in adults |journal=Ann. Hum. Biol. |volume=1 |issue=3 |pages=327–37 |date=July 1974 |pmid=4419577 |doi= |url=}}</ref><ref name="pmid15088302">{{cite journal |vauthors=Schneider DL, von Mühlen D, Barrett-Connor E, Sartoris DJ |title=Kyphosis does not equal vertebral fractures: the Rancho Bernardo study |journal=J. Rheumatol. |volume=31 |issue=4 |pages=747–52 |date=April 2004 |pmid=15088302 |doi= |url=}}</ref>
 |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>
+|<nowiki>-</nowiki>
 |
+*Typically no specific lab findings, however; CBC may be done to rule out other serious pathologies.
+|Radiography
+*Wedge-shaped vertebrae
+*Narrow intervertebral disk spaces with calcifications
+*Prominent irregularities of vertebrae
+*Arcuate [[kyphosis]]
 |
-|
+*Often begins as loss of height with normal [[aging]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Osteomyelitis|Chronic recurrent focal osteomyelitis]]
+![[Osteoarthritis]]<ref name="pmid18296075">{{cite journal |vauthors=Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R |title=Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative |journal=Osteoarthr. Cartil. |volume=16 |issue=4 |pages=415–22 |date=April 2008 |pmid=18296075 |doi=10.1016/j.joca.2007.12.017 |url=}}</ref><ref name="pmid9462165">{{cite journal |vauthors=Hurley MV, Scott DL, Rees J, Newham DJ |title=Sensorimotor changes and functional performance in patients with knee osteoarthritis |journal=Ann. Rheum. Dis. |volume=56 |issue=11 |pages=641–8 |date=November 1997 |pmid=9462165 |pmc=1752287 |doi= |url=}}</ref><ref name="pmid18203312">{{cite journal |vauthors=Sale JE, Gignac M, Hawker G |title=The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis |journal=J. Rheumatol. |volume=35 |issue=2 |pages=335–42 |date=February 2008 |pmid=18203312 |doi= |url=}}</ref>
 |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>
+|ESR
+*Elevated
+CRP
+*Elevated
+Synovial fluid analysis
+*WBCs < 2000/mm3
+*Polys < 25%
+*Culture negative
+*Crystal negative
+*Elevated IL-2, IL-5, MCP-1
+|Radiography
+*Asymmetric joint space narrowing
+*Subchondral sclerosis
+*Subchondral cysts
+MRI
+*Joint space narrowing
+*Degeneration
 |
-|
+*Gradual onset
-|
+*Polyarthritis
-|
+*Hips, knees, distal and proximal interphalyngeal joints and spine involvement
-|
+*Bouchard's and Heberden's nodes
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Cervical fracture]]
+!Sacroiliac joint dysfunction<ref name="pmid23409086">{{cite journal |vauthors=Betti L, von Cramon-Taubadel N, Manica A, Lycett SJ |title=Global geometric morphometric analyses of the human pelvis reveal substantial neutral population history effects, even across sexes |journal=PLoS ONE |volume=8 |issue=2 |pages=e55909 |date=2013 |pmid=23409086 |pmc=3567032 |doi=10.1371/journal.pone.0055909 |url=}}</ref><ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref>
-|Acute
+|Chronic
-|Minutes to hours
+|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>
-|
+|CBC
-|
+*May show [[leukocytosis]]
+ESR
+*May be elevated
+CRP
+*May be elevated
+Serology
+*[[ANA]]
+*[[Rheumatoid factor]]
+*[[HLA-B27]]
+Metabolic panel
+*May indicate hypothyroidism or cortisol abnormalities
+|Imaging is controversial, however, CT may demonstrate;
+*Reactive spurs
+*Sclerosis
+*Subluxation
+MRI
+*Used primarily to exclude [[disc herniation]]
+Nuclear imaging
+*Used to rule out stress fractures and metastatic bone disease
 |
+*[[Rehabilitation]] is often sought
 |-
-![[Degenerative disc disease]]
+!Sacroilitis<ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref><ref name="pmid6600615">{{cite journal |vauthors=Carette S, Graham D, Little H, Rubenstein J, Rosen P |title=The natural disease course of ankylosing spondylitis |journal=Arthritis Rheum. |volume=26 |issue=2 |pages=186–90 |date=February 1983 |pmid=6600615 |doi= |url=}}</ref>
-|Subacute or chronic
+|Acute or chronic
-|Years
+|Variable
-|
+|Dull aching or throbbing
-|
+|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>
-|
+|CBC
-|
-|
+*May demonstrate [[leukocytosis]]
+ESR
+*May be elevated
+CRP
+*May be elevated
+Procalcitonin
+*May be elevated
+Culture and sensitivity
+*To identify causative agent
+|MRI
+*Narrowing of joint space and low signalling indicates edema
+CT
+*Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface
+Radiography
+*Joint space narrowing with destruction of joint space
+Nuclear imaging
+*Focal uptake of gallium-67 and technetium-99m in area of destruction
+|
+*Most likely due to hematogenous spread of organism
 |-
-![[Spinal disc herniation|Disc herniation]]
+![[Kyphosis|Scheuermann (juvenile) kyphosis]]<ref name="pmid10393769">{{cite journal |vauthors=Lowe TG |title=Scheuermann's disease |journal=Orthop. Clin. North Am. |volume=30 |issue=3 |pages=475–87, ix |date=July 1999 |pmid=10393769 |doi= |url=}}</ref><ref name="pmid17184084">{{cite journal |vauthors=Codd PJ, Riesenburger RI, Klimo P, Slotkin JR, Smith ER |title=Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. Case report and review of the literature |journal=J. Neurosurg. |volume=105 |issue=6 Suppl |pages=490–5 |date=December 2006 |pmid=17184084 |doi=10.3171/ped.2006.105.6.490 |url=}}</ref>
-|Acute
+|Chronic
-|Minutes to hours
+|Years
-|
+|Dull aching
-|
+|Shoulders and arms
-|
+|<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
+*Wedge-shaped vertebra
+*Arcuate [[kyphosis]]
+*Narrow intervertebral discs with calcifications
+*Prominent irregularities of the vertebrae
+*Vertebral plates are underdeveloped and demonstrate multiple herniations of the [[nucleus pulposus]] (Schmorl nodes)
 |
+*Schmorl nodes are also seen in Wilson's disease and are not specific
 |-
-![[Discitis]]
+![[Scoliosis]]<ref name="pmid8816647">{{cite journal |vauthors=Stirling AJ, Howel D, Millner PA, Sadiq S, Sharples D, Dickson RA |title=Late-onset idiopathic scoliosis in children six to fourteen years old. A cross-sectional prevalence study |journal=J Bone Joint Surg Am |volume=78 |issue=9 |pages=1330–6 |date=September 1996 |pmid=8816647 |doi= |url=}}</ref><ref name="pmid1129452">{{cite journal |vauthors=McAlister WH, Shackelford GD |title=Classification of spinal curvatures |journal=Radiol. Clin. North Am. |volume=13 |issue=1 |pages=93–112 |date=April 1975 |pmid=1129452 |doi= |url=}}</ref><ref name="pmid4760104">{{cite journal |vauthors=Riseborough EJ, Wynne-Davies R |title=A genetic survey of idiopathic scoliosis in Boston, Massachusetts |journal=J Bone Joint Surg Am |volume=55 |issue=5 |pages=974–82 |date=July 1973 |pmid=4760104 |doi= |url=}}</ref>
 |Chronic
 |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
+*Bending of the thoracic curve is noted
+MRI
+*Used to assess additional complaints such as [[headache]]s, not routine for adolescents
 |
-|
+*Most commonly is [[idiopathic]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-!Hyperkyphosis
+![[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
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Osteoarthritis]]
+![[Compression fracture|Vertebral compression fracture]]<ref name="pmid10692972">{{cite journal |vauthors=Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N |title=Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis |journal=Osteoporos Int |volume=10 |issue=4 |pages=259–64 |date=1999 |pmid=10692972 |doi= |url=}}</ref><ref name="pmid10994823">{{cite journal |vauthors=Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE |title=Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group |journal=Mayo Clin. Proc. |volume=75 |issue=9 |pages=888–96 |date=September 2000 |pmid=10994823 |doi= |url=}}</ref><ref name="pmid12208381">{{cite journal |vauthors=Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N |title=Diagnosis and management of vertebral fractures in elderly adults |journal=Am. J. Med. |volume=113 |issue=3 |pages=220–8 |date=August 2002 |pmid=12208381 |doi= |url=}}</ref>
-|Chronic
+|Acute
-|Years
+|Minutes to hours
-|
+|Sudden, severe, sharp
-|
+|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>
-|
+|CBC
-|
-|
+*Decreased [[hematocrit]] and [[anemia]]
+[[PSA]]
+*To rule out [[prostatic cancer|prostate cancer]]
+Urine analysis
+*To detect Bence - Jones protein
+Serum protein [[electrophoresis]]
+*M spike is seen with [[multiple myeloma]]
+ESR
+*May be elevated
+|Radiography
+*Decreased vertebral body height
+CT
+*Detects more subtle fractures and calcifications
+MRI
+*Useful in those with motor weakness and sensory deficits
+*May demonstrate hemorrhage, tumor, or infection
+DRA scanning
+*Detects low bone density
+PET scanning
+*To distinguish benign from malignant causes of compression
+|
+*Presents as a midline back pain
 |-
-!Sacroiliac joint dysfunction
+![[Vertebral osteomyelitis]]<ref name="pmid11515764">{{cite journal |vauthors=Beronius M, Bergman B, Andersson R |title=Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95 |journal=Scand. J. Infect. Dis. |volume=33 |issue=7 |pages=527–32 |date=2001 |pmid=11515764 |doi= |url=}}</ref><ref name="pmid370121">{{cite journal |vauthors=Digby JM, Kersley JB |title=Pyogenic non-tuberculous spinal infection: an analysis of thirty cases |journal=J Bone Joint Surg Br |volume=61 |issue=1 |pages=47–55 |date=February 1979 |pmid=370121 |doi= |url=}}</ref><ref name="pmid1775852">{{cite journal |vauthors=McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR |title=Vertebral osteomyelitis and aortic lesions: case report and review |journal=Rev. Infect. Dis. |volume=13 |issue=6 |pages=1184–94 |date=1991 |pmid=1775852 |doi= |url=}}</ref>
-|Chronic
+|Acute
-|Years
+|Minutes to hours
-|
+|Sudden, severe, sharp
-|
+|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>
-|
+|CBC
-|
-|
+*[[Leukocytosis]] and left shift
-|-
-!Sacroilitis
+ESR
-|Acute or chronic
-|Variable
+*Elevated
-|
-|
+CRP
-|
-|
+*Elevated
-|
-|
+Procalcitonin
-|
-|
+*Elevated
-|
-|
+Culture and sensitivity
-|
-|
+*To identify causative agent
-|
+|Radiography
-|
-|
+*Demonstrates endosteal or medullary lesion
-|
+*Sequestration and cavity formation
-|
+MRI
+*[[Bone marrow]] abnormalities and lytic changes
+CT
+*Articular and periarticular involvement
+Ultrasound
+*Soft tissue abnormalities
+Nuclear imaging
+*Loss of bone density
 |
+*Often caused by hematogenous spread of organism
+|-
+! 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
 |-
-![[Kyphosis|Scheuermann (juvenile) kyphosis]]
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
-|Chronic
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
-|Years
+! 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
-|
-|
-|
-|
 |-
-![[Scoliosis]]
+! rowspan="18" align="center" style="background:#4479BA; color: #FFFFFF;" |Referred pain
-|Chronic
+![[Aortic aneurysm]]
-|Years
+rupture<ref name="pmid19786250">{{cite journal |vauthors=Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ |title=The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines |journal=J. Vasc. Surg. |volume=50 |issue=4 Suppl |pages=S2–49 |date=October 2009 |pmid=19786250 |doi=10.1016/j.jvs.2009.07.002 |url=}}</ref><ref name="pmid2359191">{{cite journal |vauthors=Sullivan CA, Rohrer MJ, Cutler BS |title=Clinical management of the symptomatic but unruptured abdominal aortic aneurysm |journal=J. Vasc. Surg. |volume=11 |issue=6 |pages=799–803 |date=June 1990 |pmid=2359191 |doi= |url=}}</ref><ref name="pmid18394857">{{cite journal |vauthors=Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ |title=Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective |journal=J. Vasc. Surg. |volume=47 |issue=6 |pages=1165–70; discussion 1170–1 |date=June 2008 |pmid=18394857 |doi=10.1016/j.jvs.2008.01.055 |url=}}</ref>
-|
+- [[Abdominal aortic aneurysm]]
-|
-|
+- [[Thoracic aortic aneurysm]]
-|
+|Acute
-|
+|Minutes to hours
-|
+|Sharp and knife-like, also tearing or ripping
-|
+|Back and/ or flanks
-|
+|<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, however, evidence of haemorrhage and organ injury may be seen in:
+*Complete blood count; normochromic normocytic anemia seen in haemorrhage
+*Elevated serum electrolytes
+*Elevated [[liver function test]]s
+*Elevated [[amylase]] or [[lipase]]
+|Ultrasonography
+*Visualization of aneurysm, size and/or rupture and hematoma
+Chest radiography
+*Visualizes calcifications in aneurysm but not specific
+CT
+*Demonstrates aortic size, extent, and involvement of organ arteries
+MRI
+*Has advantage of less radiation and no use for dye, whilst demonstrating same findings as [[ultrasound]] and [[CT]]
+[[Angiography]]
+*Allows 3D construction of aorta
+[[Echocardiography]] (Transesophageal)
+*Demonstrates fluid shift and need for cardiology intervention
 |
+*[[Livedo reticularis]] may be seen and indicates thrombotic phenomenon
 |-
-![[Spinal stenosis]]
+![[Aortic dissection]]<ref name="pmid20717014">{{cite journal |vauthors=Suzuki T, Distante A, Eagle K |title=Biomarker-assisted diagnosis of acute aortic dissection: how far we have come and what to expect |journal=Curr. Opin. Cardiol. |volume=25 |issue=6 |pages=541–5 |date=November 2010 |pmid=20717014 |doi=10.1097/HCO.0b013e32833e6e13 |url=}}</ref><ref name="pmid29146682">{{cite journal |vauthors=Wang Y, Tan X, Gao H, Yuan H, Hu R, Jia L, Zhu J, Sun L, Zhang H, Huang L, Zhao D, Gao P, Du J |title=Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection |journal=Circulation |volume=137 |issue=3 |pages=259–269 |date=January 2018 |pmid=29146682 |doi=10.1161/CIRCULATIONAHA.117.030469 |url=}}</ref><ref name="pmid27666178">{{cite journal |vauthors=Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W |title=Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=118 |issue=9 |pages=1405–1409 |date=November 2016 |pmid=27666178 |doi=10.1016/j.amjcard.2016.07.052 |url=}}</ref><ref name="pmid27666178" /><ref name="pmid11015167">{{cite journal |vauthors=Suzuki T, Katoh H, Tsuchio Y, Hasegawa A, Kurabayashi M, Ohira A, Hiramori K, Sakomura Y, Kasanuki H, Hori S, Aikawa N, Abe S, Tei C, Nakagawa Y, Nobuyoshi M, Misu K, Sumiyoshi T, Nagai R |title=Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study |journal=Ann. Intern. Med. |volume=133 |issue=7 |pages=537–41 |date=October 2000 |pmid=11015167 |doi= |url=}}</ref><ref name="pmid24036495">{{cite journal |vauthors=Marshall LM, Carlson EJ, O'Malley J, Snyder CK, Charbonneau NL, Hayflick SJ, Coselli JS, Lemaire SA, Sakai LY |title=Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation |journal=Circ. Res. |volume=113 |issue=10 |pages=1159–68 |date=October 2013 |pmid=24036495 |doi=10.1161/CIRCRESAHA.113.301498 |url=}}</ref>
-|Chronic
+|Severe and sudden (acute) and rarely, chronic
-|
+|Minutes to hours
-|
+|Sharp and knife-like, also tearing or ripping
-|
+|Back and/or flanks
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+| -
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>+/-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>+</nowiki>
-|
+|<nowiki>+/-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|Elevations in:
-|
-|
+*[[D - dimer]]
-|-
+*Smooth muscle myosin heavy chain
-![[Spondylosis]]
+*Soluble ST2
-|Chronic
+*Soluble elastin fragments
-|
+*High -sensitivity C-reactive protein
-|
+*[[Fibrinogen]]
-|
+*Fibrillin fragments
-|
+|ECG:
-|
-|
+*Normal
-|
+*Non - specific ST wave changes
-|
+*Hypertrophy patterns
-|
+*ST segment elevation indicating myocardial infarction
-|
-|
+Chest radiography:
-|
-|
+*Normal
-|
+*Mediastinal or aortic widening
-|
-|
-|
-|
-|
-|-
-![[Compression fracture|Vertebral compression fracture]]
-|Acute
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |
+*Increased risk of occurence with [[Marfan syndrome]]
+|-
+![[Appendicitis]]<ref name="pmid9015177">{{cite journal |vauthors=Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH |title=Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis |journal=World J Surg |volume=21 |issue=3 |pages=313–7 |date=1997 |pmid=9015177 |doi= |url=}}</ref><ref name="pmid22071846">{{cite journal |vauthors=Wilms IM, de Hoog DE, de Visser DC, Janzing HM |title=Appendectomy versus antibiotic treatment for acute appendicitis |journal=Cochrane Database Syst Rev |volume= |issue=11 |pages=CD008359 |date=November 2011 |pmid=22071846 |doi=10.1002/14651858.CD008359.pub2 |url=}}</ref><ref name="pmid17192449">{{cite journal |vauthors=Becker T, Kharbanda A, Bachur R |title=Atypical clinical features of pediatric appendicitis |journal=Acad Emerg Med |volume=14 |issue=2 |pages=124–9 |date=February 2007 |pmid=17192449 |doi=10.1197/j.aem.2006.08.009 |url=}}</ref>
+|Acute
+|Minutes to hours
+|Burning
+|Umbilicus and lower right quadrant
+|<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
+*Demonstrates [[leukocytosis]] and [[neutrophilia]]
+CRP
+*May be elevated
+Urine analysis
+*May demonstrate [[pyuria]], [[hematuria]], and/or [[proteinuria]]
+Urine 5-HIAA
+*Maybe an early marker of [[appendictis]]
+*Sudden increase may indicate [[necrosis]]
+|Ultrasound
+*Demonstrates a non-compressible tubular structure
+CT
+*Demonstrates an enlarged [[appendix]] with thickened walls and can detect abnormally located appendices
+MRI
+*Useful in pregnant ladies
+KUB Radiography
+*May detect an appendicolith
+[[Barium enema]]
+*Demonstrates absent or incomplete filling
+*Cecal spasm may be present
+Radionuclide scanning
+*Appendiceal inflammation may be present
 |
+*Pain begins around the [[umbilicus]] and then shifts to [[RUQ]]
+|-
+![[Gallstone disease|Cholelithiasis]]<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |date=July 1990 |pmid=2368790 |doi= |url=}}</ref><ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |date=April 2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
+|Acute or subacute
+|Minutes or hours
+|Sharp
+|Tip of right shoulder
+| -
+|<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
+*Demonstrates polymorphnuclear [[leukocytosis]]
+LFT
+*Elevated [[alanine aminotransferase]] and [[aspartate aminotransferases]]
+*Elevated conjugated [[bilirubin]]
+[[Amylase]] and [[lipase]]
+*Elevated
+|Radiography
+*Radio-opaque stones may be present
+CT
+*May indicate presence of [[gallstones]] in the distal [[common bile duct]]
+MRI
+**May indicate presence of [[gallstones]] in the distal [[common bile duct]]
+Ultrasound
+*May demonstrate gallbladder wall thickening (>5 mm) and gallbladder fluid and distention
+*Gallstones may appear as echogenic foci that cast an [[acoustic shadow]]
+Scintigraphy
+*May detect cystic duct obstruction
+ERCP
+*Stones are seen as a filling defect and can be removed simultaneously
+PTC
+*Similar to ERCP
+*Used when ERCP is not feasible
 |
+*May be completely asymptomatic
 |-
-![[Vertebral osteomyelitis]]
+![[Chronic stable angina]]<ref name="pmid17197405">{{cite journal |vauthors=Kreiner M, Okeson JP, Michelis V, Lujambio M, Isberg A |title=Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study |journal=J Am Dent Assoc |volume=138 |issue=1 |pages=74–9 |date=January 2007 |pmid=17197405 |doi= |url=}}</ref><ref name="pmid3970650">{{cite journal |vauthors=Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L |title=Acute chest pain in the emergency room. Identification and examination of low-risk patients |journal=Arch. Intern. Med. |volume=145 |issue=1 |pages=65–9 |date=January 1985 |pmid=3970650 |doi= |url=}}</ref>
 |Chronic
+|Variable
+|Discomfort in the chest
+|Left shoulder, arm and jaw
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/- </nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+|Detection of:
+*Urinary proton nuclear magnetic resonance spectroscopy
+*Toll-like receptors 2 and 4 (TLR-2 and TLR-4)  on platelets
+|Chest radiography
+*Normal, may show [[calcification]] or complications such as [[pleural effusion]]
+Exercise stress testing
+*Establishes diagnosis and extent of [[angina]]
+Stress Echo
+*To evaluate wall motion, normal in [[stable angina]]
+Nuclear imaging
+*To assess myocardial perfusion, reduced in [[stable angina]]
+CT
+*To evaluate coronary artery calcium (cac) which may or may not be elevated
+CT Angiography
+*To evaluate [[stenosis]], <70% in [[stable angina]]
+EKG
+*Normal in [[stable angina]]
 |
-|
+*Hallmark is relief by rest or sublingual [[nitroglycerin]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
+![[Cystitis]]<ref name="pmid24484571">{{cite journal |vauthors=Foxman B |title=Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden |journal=Infect. Dis. Clin. North Am. |volume=28 |issue=1 |pages=1–13 |date=March 2014 |pmid=24484571 |doi=10.1016/j.idc.2013.09.003 |url=}}</ref><ref name="pmid22417256">{{cite journal |vauthors=Hooton TM |title=Clinical practice. Uncomplicated urinary tract infection |journal=N. Engl. J. Med. |volume=366 |issue=11 |pages=1028–37 |date=March 2012 |pmid=22417256 |doi=10.1056/NEJMcp1104429 |url=}}</ref><ref name="pmid22393148">{{cite journal |vauthors=Gupta K, Trautner B |title=In the clinic. Urinary tract infection |journal=Ann. Intern. Med. |volume=156 |issue=5 |pages=ITC3–1–ITC3–15; quiz ITC3–16 |date=March 2012 |pmid=22393148 |doi=10.7326/0003-4819-156-5-201203060-01003 |url=}}</ref>
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
+|Acute
-! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
+|Hours
-! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
+|Burning
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
+|Suprapubic
+|<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>
+||Urine analysis
+*May demonstrate [[pyuria[[, [[hematuria]], [[white blood cell]] casts and [[proteinuria]]
+Urine culture
+*Detection of > 1000 colony-forming units/ml
+CBC
+*May demonstrate [[leukocytosis]] and/or [[anemia]]
+|
+*Typically no routine imaging done
+|
+*Cystitis may be infectious, hemorrhagic, radiational, or sterile
 |-
-! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
+![[Endocarditis]]<ref name="pmid26320109">{{cite journal |vauthors=Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL |title=2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) |journal=Eur. Heart J. |volume=36 |issue=44 |pages=3075–3128 |date=November 2015 |pmid=26320109 |doi=10.1093/eurheartj/ehv319 |url=}}</ref><ref name="pmid11479467">{{cite journal |vauthors=Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A |title=Cardiac conduction abnormalities in endocarditis defined by the Duke criteria |journal=Am. Heart J. |volume=142 |issue=2 |pages=280–5 |date=August 2001 |pmid=11479467 |doi=10.1067/mhj.2001.116964 |url=}}</ref><ref name="pmid26341945">{{cite journal |vauthors=Cahill TJ, Prendergast BD |title=Infective endocarditis |journal=Lancet |volume=387 |issue=10021 |pages=882–93 |date=February 2016 |pmid=26341945 |doi=10.1016/S0140-6736(15)00067-7 |url=}}</ref>
-! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
+|Acute or subacute
-! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
+|Variable
-! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
+|Discomfort in the chest
-|-
+|Jaw and arms
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
+|<nowiki>+</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit
+|CBC
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction
+*[[Anemia]] and [[leukocytosis]] may be noted
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
+Serology
+*Decrease C3, C4, and CH50 may indicate [[subacute endocarditis]]
+*[[Rheumatoid factor]] may be positive
+ESR
+*May be elevated
+Urine analysis
+*May demonstrate [[proteinuria]] and microscopic [[hematuria]]
+Blood culture
+*To identify causative agent
+*Streptococci and HACEK organisms are culture negative
+*Organisms that grow on prosthetic valves tend to be coagulase-negative staphylococci
+|Echocardiography
+*Vegetations and myocardial abscesses may be present
+Radiography
+*Pyogenic [[emboli]] may be seen across the lung field
+Ultrasound
+*Myocardial abscesses may be seen
+*Valvular dysfunction may also be noted
+|
+*IV drug users and those who suffer from [[rheumatic heart disease]] often present with [[infective endocarditis]]
 |-
-! rowspan="12" align="center" style="background:#4479BA; color: #FFFFFF;" |Non-spinal infections
+![[Myalgia]]<ref name="pmid7677303">{{cite journal |vauthors=Gumber SC, Chopra S |title=Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations |journal=Ann. Intern. Med. |volume=123 |issue=8 |pages=615–20 |date=October 1995 |pmid=7677303 |doi= |url=}}</ref><ref name="pmid3404526">{{cite journal |vauthors=Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D |title=Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase |journal=J R Soc Med |volume=81 |issue=6 |pages=326–9 |date=June 1988 |pmid=3404526 |pmc=1291623 |doi=10.1177/014107688808100608 |url=}}</ref><ref name="pmid18452688">{{cite journal |vauthors=Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD |title=Diagnosis and treatment of Lyme disease |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=566–71 |date=May 2008 |pmid=18452688 |doi=10.4065/83.5.566 |url=}}</ref>
-![[Appendicitis]]
+|Chronic
-|Acute
+|Years
-|
+|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>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|*Typically no specific lab findings
-|
-|
+*A full workup should be done to exclude other etiologies, such as;
-|
-|-
+[[Rheumatoid factor]] and/or anti-cyclic citrullinated peptide antibodies
-![[Endocarditis]]
-|Acute or subacute
+*May indicate cause is [[rheumatoid arthritis]]
-|
-|
+CRP and ESR
-|
-|
+*May be elevated
-|
-|
+CBC
-|
-|
+*May indicate [[anemia]]
-|
-|
+Bone profile
-|
-|
+*May be caused by a [[vitamin D]] or calcium deficiency
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Gallstone disease|Cholelithiasis]]
-|Acute or subacute
-|Minutes or hours
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |
+*Typically no routine imaging done
 |
+*May be associated with [[Hepatitis C]] and [[Lyme disease]]
+|-
+![[Kidney stone|Nephrolithiasis]]<ref name="pmid23283137">{{cite journal |vauthors=Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z |title=Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States |journal=Kidney Int. |volume=83 |issue=3 |pages=479–86 |date=March 2013 |pmid=23283137 |pmc=3587650 |doi=10.1038/ki.2012.419 |url=}}</ref><ref name="pmid12618515">{{cite journal |vauthors=Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson RF, Kuo RL, Grynpas M |title=Randall's plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle |journal=J. Clin. Invest. |volume=111 |issue=5 |pages=607–16 |date=March 2003 |pmid=12618515 |pmc=151900 |doi=10.1172/JCI17038 |url=}}</ref><ref name="pmid15592050">{{cite journal |vauthors=Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH, Munch LC, Evan AP, Lingeman JE |title=Stone formation is proportional to papillary surface coverage by Randall's plaque |journal=J. Urol. |volume=173 |issue=1 |pages=117–9; discussion 119 |date=January 2005 |pmid=15592050 |doi=10.1097/01.ju.0000147270.68481.ce |url=}}</ref>
+|Acute
+|Hours
+|Severe, sharp
+|Abdomen, hips, groin, 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>
+|CBC
+*Mild [[leukocytosis]] may indicate infection
+Electrolytes
+*[[Hypokalemia]] may indicate [[acute tubular necrosis]]
+*[[Hypercalcemia]] or [[hypercalciuria]] may be detected
+Creatinine
+*To identify potential renal injury with contrast
+Uric acid
+*[[Uric acid]] stones sometimes occur with gout
+ABG
+*May indicate  [[acute tubular necrosis]] with [[hypokalemia]] and decreased bicarbonate
+|CT
+*Visualizes [[calcium]] stones and other possible pathologies, such as [[hydronephrosis]]
+IVP
+*Visualizes stones and entire urinary system
+KUB radiography
+*Radio-opaque stones may be present
+Ultrasound
+*For visualization of stones
+Plain renal tomography
+*Can distinguish between intrarenal and extrarenal calcifications
+Retrograde pyelography
+*Particularly useful for ureteric calculi visualization
+Nuclear renal imaging
+*May determine a decreased renal function
 |
+*Hypercalcemia may indicate primary or secondary [[hyperparathyroidism]]
+|-
+![[Pancreatitis]]<ref name="pmid15199038">{{cite journal |vauthors=Swaroop VS, Chari ST, Clain JE |title=Severe acute pancreatitis |journal=JAMA |volume=291 |issue=23 |pages=2865–8 |date=June 2004 |pmid=15199038 |doi=10.1001/jama.291.23.2865 |url=}}</ref><ref name="pmid12094843">{{cite journal |vauthors=Yadav D, Agarwal N, Pitchumoni CS |title=A critical evaluation of laboratory tests in acute pancreatitis |journal=Am. J. Gastroenterol. |volume=97 |issue=6 |pages=1309–18 |date=June 2002 |pmid=12094843 |doi=10.1111/j.1572-0241.2002.05766.x |url=}}</ref><ref name="pmid8540502">{{cite journal |vauthors=Fortson MR, Freedman SN, Webster PD |title=Clinical assessment of hyperlipidemic pancreatitis |journal=Am. J. Gastroenterol. |volume=90 |issue=12 |pages=2134–9 |date=December 1995 |pmid=8540502 |doi= |url=}}</ref>
+|Acute or chronic
+|Variable
+|Severe, sharp or dull aching
+|Abdomen
+|<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>
+|Amylase and lipase
+*Elevated
+LFT
+*Elevated [[alkaline phosphatase]], total [[bilirubin]], [[aspartate aminotransferase]], and [[alanine aminotransferase]]
+CBC
+*May demonstrate [[leukocytosis]]
+Serum electrolytes
+*May indicate hypo or [[hypercalcemia]]
+BUN and creatinine
+*May be elevated
+Triglycerides
+*Usually elevated, however, falsely lowered during acute attack
+|KUB radiography
+*May demonstrate free air within abdomen, indicating a perforated viscus
+Ultrasound
+*Used to visualize the pancreas and biliary tree
+*May detect microlithiasis and periampullary lesions
+CT
+*[[Pancreas]] may appear enlarged
+MRC
+*May demonstrate a blockage within the biliary ducts
+ERCP
+*May remove a blockage, however, can in fact cause [[pancreatitis]]
 |
+*Usually caused by binge drinking or long standing gallstones that block the [[ampulla of Vater]]
+*[[Vomiting]] is a common manifestation
+|-
+![[Pelvic inflammatory disease]]<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |date=May 2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref><ref name="pmid24216035">{{cite journal |vauthors=Ross J, Judlin P, Jensen J |title=2012 European guideline for the management of pelvic inflammatory disease |journal=Int J STD AIDS |volume=25 |issue=1 |pages=1–7 |date=January 2014 |pmid=24216035 |doi=10.1177/0956462413498714 |url=}}</ref><ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |date=June 2015 |pmid=26042815 |doi= |url=}}</ref>
+|Acute or chronic
+|Variable
+|Dullaching or throbbing
+|Hips, groin, 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>
+|CBC
+*[[Leukocytosis]], may indicate infection with [[trichomoniasis]]
+Pregnancy test
+*To rule out [[ectopic pregnancy]]
+STD panel
+*To rule out [[gonorrhea]], [[chlamydia]], [[hepatitis B]] and C, [[HIV]], and [[syphilis]]
+Urine analysis
+*To rule out a [[urinary tract infection]]
+|Transvaginal ultrasound
+*May demonstrate anechoic structures in adnexa indicating hydrosalpinx and/or pyosalpinx
+Laparoscopy
+*May demonstrate adhesions (Asherman's syndrome) or gun powder lesions ([[Endometriosis]]) or an [[ectopic pregnancy]]
+MRI and CT
+*May indicate hydro and/ or pyosalpinx
 |
+*Inflammation may spread to perihepatic structures (Fitz-Hugh−Curtis syndrome)
 |-
-![[Cystitis]]
+![[Pulmonary embolism]]<ref name="pmid25377011">{{cite journal |vauthors=Lassila R, Jula A, Pitkäniemi J, Haukka J |title=The association of statin use with reduced incidence of venous thromboembolism: a population-based cohort study |journal=BMJ Open |volume=4 |issue=11 |pages=e005862 |date=November 2014 |pmid=25377011 |pmc=4225235 |doi=10.1136/bmjopen-2014-005862 |url=}}</ref><ref name="pmid12885687">{{cite journal |vauthors=Horlander KT, Mannino DM, Leeper KV |title=Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data |journal=Arch. Intern. Med. |volume=163 |issue=14 |pages=1711–7 |date=July 2003 |pmid=12885687 |doi=10.1001/archinte.163.14.1711 |url=}}</ref><ref name="pmid1560799">{{cite journal |vauthors=Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI, Schwartz JS, Thompson BT, Popovich J, Hobbins TE |title=The clinical course of pulmonary embolism |journal=N. Engl. J. Med. |volume=326 |issue=19 |pages=1240–5 |date=May 1992 |pmid=1560799 |doi=10.1056/NEJM199205073261902 |url=}}</ref>
 |Acute
+|Minutes
+|Severe, sharp
+|Chest and back
+|<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>
+|Lab findings are not specfic and are done to rule out other diseases such as:
+*[[Antithrombin]] III deficiency
+*[[Protein C]]or [[protein S]] deficiency
+*[[Lupus]]
+*Homocystinuria
+*Malignancy
+*Connective tissue disorders
 |
+*D - dimer is positive and ventilation- perfusion scanning will show a a perfusion/ventilation mismatch
+*CT Angiography and duplex angiography are able to visualize the embolism
 |
+*PE may occur even in patients that are fully anticoagulated
+*[[DVT]] is a common source
+|-
+![[Pyelonephritis]]<ref name="pmid21292654">{{cite journal |vauthors=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE |title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases |journal=Clin. Infect. Dis. |volume=52 |issue=5 |pages=e103–20 |date=March 2011 |pmid=21292654 |doi=10.1093/cid/ciq257 |url=}}</ref>
+|Acute or chronic
+|Variable
+|Severe, sharp or dull aching
+|Groin, 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>
+|CRP
+*Elevated
+ESR
+*Elevated
+Urinalysis
+*[[Pyuria]]
+*Bacteriuria
+*May be nitrite positive (gram negative organisms)
+*Culture positibe (Uncomplicated: E. coli, [[Proteus mirabialis]], Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis
+|Ultrasound
+*[[Hydronephrosis]]
+Non-contrast CT
+*Pelvicalceal dilation
+*Cortical involvement
+MRI
+*T1: affected region(s) appear hypointense compared with the normal kidney parenchyma
+*T2: hyperintense compared to normal kidney parenchyma
+*T1 C+: reduced enhancement
 |
-|
+*Renal stones
-|
+*Obstruction
-|
+*[[Pregnancy]]
-|
+*Prolonged urinary catheterization
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Myalgia]]
+![[Pneumonia]]<ref name="pmid14683661">{{cite journal |vauthors=File TM |title=Community-acquired pneumonia |journal=Lancet |volume=362 |issue=9400 |pages=1991–2001 |date=December 2003 |pmid=14683661 |doi=10.1016/S0140-6736(03)15021-0 |url=}}</ref><ref name="pmid28763554">{{cite journal |vauthors=Shah SN, Bachur RG, Simel DL, Neuman MI |title=Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review |journal=JAMA |volume=318 |issue=5 |pages=462–471 |date=August 2017 |pmid=28763554 |doi=10.1001/jama.2017.9039 |url=}}</ref><ref name="pmid9538601">{{cite journal |vauthors=Pereira JC, Escuder MM |title=The importance of clinical symptoms and signs in the diagnosis of community-acquired pneumonia |journal=J. Trop. Pediatr. |volume=44 |issue=1 |pages=18–24 |date=February 1998 |pmid=9538601 |doi= |url=}}</ref>
-|Chronic
+|Acute or chronic
-|
+|Variable
-|
+|Variable
-|
+|Chest, back and abdomen
-|
+|<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
+*[[Leukocytosis]] is often demonstrated however, [[white blood cell]] count may be normal
+Blood culture
+*To identify causative organism or rule out other organisms such as MRSA
+|Radiography
+*Plain x-ray shows multiple patches in the lung fields
+CT
+*Used to distinguish pneumonia from non-pneumonias
 |
+*Hospital-acquired pneumonia is common
+|-
+![[Pyomyositis]]<ref name="pmid15380499">{{cite journal |vauthors=Crum NF |title=Bacterial pyomyositis in the United States |journal=Am. J. Med. |volume=117 |issue=6 |pages=420–8 |date=September 2004 |pmid=15380499 |doi=10.1016/j.amjmed.2004.03.031 |url=}}</ref><ref name="pmid1420680">{{cite journal |vauthors=Christin L, Sarosi GA |title=Pyomyositis in North America: case reports and review |journal=Clin. Infect. Dis. |volume=15 |issue=4 |pages=668–77 |date=October 1992 |pmid=1420680 |doi= |url=}}</ref><ref name="pmid5722778">{{cite journal |vauthors=Horn CV, Master S |title=Pyomyositis tropicans in Uganda |journal=East Afr Med J |volume=45 |issue=7 |pages=463–71 |date=July 1968 |pmid=5722778 |doi= |url=}}</ref><ref name="pmid8478386">{{cite journal |vauthors=Rodgers WB, Yodlowski ML, Mintzer CM |title=Pyomyositis in patients who have the human immunodeficiency virus. Case report and review of the literature |journal=J Bone Joint Surg Am |volume=75 |issue=4 |pages=588–92 |date=April 1993 |pmid=8478386 |doi= |url=}}</ref>
+|Acute or chronic
+|Days to weeks
+|Dull aching or throbbing
+|Variable
+|<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>
+|CBC
+*Demonstrates [[leukocytosis]]
+ESR
+*Elevated
+Serum [[creatine kinase]] and [[aldolase ]]
+*Normal
+Blood culture
+*Typically negative
+Culture and sensitivity
+*May include a positive gram stain
+|MRI
+*Can differentiate between [[osteomyelitis]] and pyomyositis by demonstrating early muscle inflammation or abscess formation
+CT
+*May demonstrate pphypertrophy]] of muscles and/or effacement of fatty plane
+*An enhancement in contrast may indicate abscess formation
+Ultrasound
+*Useful in determining specific muscle involvement
+Gallium scan
+*Useful in detecting early muscle pathology
 |
+*Infectious myositis was once considered a tropical disease, however with the emergence of HIV is now prevalent in western societies too
 |-
-![[Kidney stone|Nephrolithiasis]]
+![[Rheumatoid arthritis]]<ref name="pmid26435495">{{cite journal |vauthors=Louati K, Berenbaum F |title=Fatigue in chronic inflammation - a link to pain pathways |journal=Arthritis Res. Ther. |volume=17 |issue= |pages=254 |date=October 2015 |pmid=26435495 |pmc=4593220 |doi=10.1186/s13075-015-0784-1 |url=}}</ref><ref name="pmid12860726">{{cite journal |vauthors=Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL |title=Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years |journal=Ann. Rheum. Dis. |volume=62 |issue=8 |pages=722–7 |date=August 2003 |pmid=12860726 |pmc=1754626 |doi= |url=}}</ref><ref name="pmid16947780">{{cite journal |vauthors=Turesson C, Schaid DJ, Weyand CM, Jacobsson LT, Goronzy JJ, Petersson IF, Dechant SA, Nyähll-Wåhlin BM, Truedsson L, Sturfelt G, Matteson EL |title=Association of HLA-C3 and smoking with vasculitis in patients with rheumatoid arthritis |journal=Arthritis Rheum. |volume=54 |issue=9 |pages=2776–83 |date=September 2006 |pmid=16947780 |doi=10.1002/art.22057 |url=}}</ref>
-|Acute
+|Chronic
-|
+|Years
-|
+|Severe, aching
-|
+|Variable
-|
+|<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>
-|
+|ESR and CRP
-|
-|
+*Elevated
-|-
-![[Pancreatitis]]
+CBC
-|Acute or chronic
-|Variable
+*May indicate [[anemia]]
-|
-|
+[[Rheumatoid factor]]
-|
-|
+*May be positive
-|
-|
+ANA
-|
-|
+*May be positive
-|
-|
+Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin (anti-MCV)
-|
-|
+*Are specific to [[rheumatoid arthritis]]
-|
+|Radiography
-|
-|
+*[[Osteopenia]] is noted
+*Metacarpal bone erosion
+*Narrow joint space without osteophytes
+MRI
+*Pannus formation may be noted
+Ultrasound
+*Effusion of joint may be seen
 |
+*Symmetric polyarthritis
+*Morning stiffness with improvement throughout the day
+*Deformities of the hand are common
+|-
+![[Traumatic aortic rupture]]<ref name="pmid10780601">{{cite journal |vauthors=Dyer DS, Moore EE, Ilke DN, McIntyre RC, Bernstein SM, Durham JD, Mestek MF, Heinig MJ, Russ PD, Symonds DL, Honigman B, Kumpe DA, Roe EJ, Eule J |title=Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients |journal=J Trauma |volume=48 |issue=4 |pages=673–82; discussion 682–3 |date=April 2000 |pmid=10780601 |doi= |url=}}</ref><ref name="pmid9820704">{{cite journal |vauthors=Mirvis SE, Shanmuganathan K, Buell J, Rodriguez A |title=Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury |journal=J Trauma |volume=45 |issue=5 |pages=922–30 |date=November 1998 |pmid=9820704 |doi= |url=}}</ref>
+|Acute
+|Minutes to hours
+|Sharp and knife-like, also tearing or ripping
+|Back and/ or flanks
+|<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, however, evidence of [[hemorrhage]] and organ injury may be seen in:
+*Complete blood count; [[normochromic normocytic anemia]] seen in [[hemorrhage]]
+*Elevated serum electrolytes
+*Elevated liver function tests
+*Elevated [[amylase]] or [[lipase]]
+|Ultrasonography
+*Visualization of rupture, size and [[hematoma]]
+CT
+*Demonstrates intimal flap, hematoma, filling defect, aortic contour abnormality, pseudoaneurysm, vessel wall disruption, and extravasation of intravenous contrast
+MRI
+*Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT
+Angiography
+*Allows 3D construction of aorta
+Echocardiography (Transesophageal)
+*Demonstrates fluid shift and need for cardiology intervention
 |
+*Mostly caused by automobile accidents
+|-
+![[Adrenal hemorrhage|Waterhouse-Friderichsen syndrome]]<ref name="pmid5006579">{{cite journal |vauthors=Migeon CJ, Kenny FM, Hung W, Voorhess ML |title=Study of adrenal function in children with meningitis |journal=Pediatrics |volume=40 |issue=2 |pages=163–83 |date=August 1967 |pmid=5006579 |doi= |url=}}</ref><ref name="pmid13932989">{{cite journal |vauthors=MARGARETTEN W, NAKAI H, LANDING BH |title=Septicemic adrenal hemorrhage |journal=Am. J. Dis. Child. |volume=105 |issue= |pages=346–51 |date=April 1963 |pmid=13932989 |doi= |url=}}</ref>
+|Acute
+|Minutes to hours
+|Sudden, severe, sharp
+|Back and/or flanks
+|<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 decreased [[hemotocrit]], [[leukocytosis]] and rarely, [[eosinophilia]]
+Serum electrolytes
+*[[Hyponatremia]]
+*[[Hyperkalemia]]
+*[[Hypercalcemia]]
+[[Blood urea nitrogen]]
+*Elevated
+[[Creatinine]]
+*Elevated
+Plasma glucose
+*[[Hypoglycemia]]
+Serum [[cortisol]]
+*Decreased
+Plasma [[ACTH]]
+*Elevated
+|CT
+*Shows adrenal enlargement or adrenal aymmetry
 |
+*Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis
+|-
+! 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
 |-
-![[Pyelonephritis]]
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
-|Acute or chronic
+! 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
-|
-|
-|
-|
 |-
-![[Pelvic inflammatory disease]]
+! rowspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" |Tumors
-|Acute or chronic
+![[Ewing's sarcoma]]<ref name="pmid10963639">{{cite journal |vauthors=Cotterill SJ, Ahrens S, Paulussen M, Jürgens HF, Voûte PA, Gadner H, Craft AW |title=Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group |journal=J. Clin. Oncol. |volume=18 |issue=17 |pages=3108–14 |date=September 2000 |pmid=10963639 |doi=10.1200/JCO.2000.18.17.3108 |url=}}</ref><ref name="pmid2213103">{{cite journal |vauthors=Nesbit ME, Gehan EA, Burgert EO, Vietti TJ, Cangir A, Tefft M, Evans R, Thomas P, Askin FB, Kissane JM |title=Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study |journal=J. Clin. Oncol. |volume=8 |issue=10 |pages=1664–74 |date=October 1990 |pmid=2213103 |doi=10.1200/JCO.1990.8.10.1664 |url=}}</ref><ref name="pmid9053479">{{cite journal |vauthors=Raney RB, Asmar L, Newton WA, Bagwell C, Breneman JC, Crist W, Gehan EA, Webber B, Wharam M, Wiener ES, Anderson JR, Maurer HM |title=Ewing's sarcoma of soft tissues in childhood: a report from the Intergroup Rhabdomyosarcoma Study, 1972 to 1991 |journal=J. Clin. Oncol. |volume=15 |issue=2 |pages=574–82 |date=February 1997 |pmid=9053479 |doi=10.1200/JCO.1997.15.2.574 |url=}}</ref>
-|
+|Chronic
-|
+|Months to years
-|
+|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>
-|
+|<nowiki>-</nowiki>
 |
+Tests are used to rule out other pathologies;
+CBC
+*May indicate [[anemia]]
+Blood cultures
+*May be positive for various organisms
+ESR and CRP
+*May be elevated
+LDH
+*May be elevated
+Cytogenetic studies
+*May be positive for t(11;22) translocation
+Immunohistochemical markers
+*May be positive for MIC2 antigen (CD99)
+|Radiography
+*Periosteal reaction "onion skin"
+*Cortical thinning
+*Mottling
+MRI
+*Skip lesions
+*Edema
+*Metastasis
+PET - FDG
+*To identify metastatic disease
 |
 |-
-![[Pneumonia]]
+![[Langerhans cell histiocytosis]]<ref name="pmid16047354">{{cite journal |vauthors=Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H |title=Risk factors for diabetes insipidus in langerhans cell histiocytosis |journal=Pediatr Blood Cancer |volume=46 |issue=2 |pages=228–33 |date=February 2006 |pmid=16047354 |doi=10.1002/pbc.20425 |url=}}</ref><ref name="pmid8950330">{{cite journal |vauthors=Baumgartner I, von Hochstetter A, Baumert B, Luetolf U, Follath F |title=Langerhans'-cell histiocytosis in adults |journal=Med. Pediatr. Oncol. |volume=28 |issue=1 |pages=9–14 |date=January 1997 |pmid=8950330 |doi= |url=}}</ref><ref name="pmid8888814">{{cite journal |vauthors=Malpas JS, Norton AJ |title=Langerhans cell histiocytosis in the adult |journal=Med. Pediatr. Oncol. |volume=27 |issue=6 |pages=540–6 |date=December 1996 |pmid=8888814 |doi=10.1002/(SICI)1096-911X(199612)27:6<540::AID-MPO6>3.0.CO;2-L |url=}}</ref><ref name="pmid8888814">{{cite journal |vauthors=Malpas JS, Norton AJ |title=Langerhans cell histiocytosis in the adult |journal=Med. Pediatr. Oncol. |volume=27 |issue=6 |pages=540–6 |date=December 1996 |pmid=8888814 |doi=10.1002/(SICI)1096-911X(199612)27:6<540::AID-MPO6>3.0.CO;2-L |url=}}</ref>(eosinophilic granulomas)
-|Acute or chronic
+|Chronic
+|Months to years
+|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>
+|<nowiki>-</nowiki>
+|Tests used to rule out other pathologies;
+CBC
+*[[Reticulocyte]] count may be increased
+*Positive or negative direct and indirect [[Coombs test]]
+*[[Immunoglobulin]] levels may be elevated
+ESR
+*May be elevated
+LFT
+*May demonstrate elevations in total [[protein]], [[albumin]], [[alanine aminotransferase]], [[aspartate aminotransferase]], [[alkaline phosphatase]], and gamma-glutamyltransferase
+*Elevations may mean [[liver cirrhosis]]
+Urine analysis
+*Decrease in urine osmolality may indicate [[diabetes insipidus]]
+|Radiography
+*Single or multiple osteolytic lesions may be noted
+CT
+*To identify abnormalities of the hypothalamic and/or pituitary region
+MRI
+*To identify abnormalities of the hypothalamic and/or pituitary region
+PET - FDG
+*More sensitive than CT or MRI to active disease
 |
+|-
+![[Leukemia]]<ref name="pmid27647842">{{cite journal |vauthors=Clarke RT, Van den Bruel A, Bankhead C, Mitchell CD, Phillips B, Thompson MJ |title=Clinical presentation of childhood leukaemia: a systematic review and meta-analysis |journal=Arch. Dis. Child. |volume=101 |issue=10 |pages=894–901 |date=October 2016 |pmid=27647842 |doi=10.1136/archdischild-2016-311251 |url=}}</ref><ref name="pmid3879812">{{cite journal |vauthors=Konopka JB, Witte ON |title=Detection of c-abl tyrosine kinase activity in vitro permits direct comparison of normal and altered abl gene products |journal=Mol. Cell. Biol. |volume=5 |issue=11 |pages=3116–23 |date=November 1985 |pmid=3879812 |pmc=369126 |doi= |url=}}</ref><ref name="pmid28055103">{{cite journal |vauthors=Siegel RL, Miller KD, Jemal A |title=Cancer Statistics, 2017 |journal=CA Cancer J Clin |volume=67 |issue=1 |pages=7–30 |date=January 2017 |pmid=28055103 |doi=10.3322/caac.21387 |url=}}</ref><ref name="pmid10403855">{{cite journal |vauthors=Faderl S, Talpaz M, Estrov Z, O'Brien S, Kurzrock R, Kantarjian HM |title=The biology of chronic myeloid leukemia |journal=N. Engl. J. Med. |volume=341 |issue=3 |pages=164–72 |date=July 1999 |pmid=10403855 |doi=10.1056/NEJM199907153410306 |url=}}</ref>
+|Acute or chronic
+|Weeks to years
+|Aching
+|Variable
+| -
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>+</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|CBC
+*Mature or immature [[leukocytosis]]
+Coagulation study
+*May demonstrate elevated[[ prothrombin time]], decreasing [[fibrinogen]] level, and presence of fibrin split products
+Peripheral blood smear
+*May demonstrate blasts, ppschistocyte]]s, auer rods, and mature [[lymphocytosis]]
+Blood chemistry profile
+*May demonstrate [[tumor lysis syndrome]] through elevated [[LDH]] and [[uric acid]]
+Blood culture
+*To rule out infection
 |
+*Typically no routine imaging studies, cytogenetic and flow cytometries aid diagnosis
 |
+*Acute and chronic, lymphocytic and myeloid diagnoses are based on the presence and type of blast or mature cell
+|-
+![[Lymphoma]]<ref name="pmid7139563">{{cite journal |vauthors=Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM, DeVita VT |title=Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute |journal=Cancer |volume=50 |issue=12 |pages=2699–707 |date=December 1982 |pmid=7139563 |doi= |url=}}</ref><ref name="pmid15798767">{{cite journal |vauthors=Mohren M, Markmann I, Jentsch-Ullrich K, Koenigsmann M, Lutze G, Franke A |title=Increased risk of thromboembolism in patients with malignant lymphoma: a single-centre analysis |journal=Br. J. Cancer |volume=92 |issue=8 |pages=1349–51 |date=April 2005 |pmid=15798767 |doi=10.1038/sj.bjc.6602504 |url=}}</ref><ref name="pmid1303125">{{cite journal |vauthors=Cozen W, Katz J, Mack TM |title=Risk patterns of Hodgkin's disease in Los Angeles vary by cell type |journal=Cancer Epidemiol. Biomarkers Prev. |volume=1 |issue=4 |pages=261–8 |date=1992 |pmid=1303125 |doi= |url=}}</ref><ref name="pmid21054151">{{cite journal |vauthors=Bazzeh F, Rihani R, Howard S, Sultan I |title=Comparing adult and pediatric Hodgkin lymphoma in the Surveillance, Epidemiology and End Results Program, 1988-2005: an analysis of 21 734 cases |journal=Leuk. Lymphoma |volume=51 |issue=12 |pages=2198–207 |date=December 2010 |pmid=21054151 |doi=10.3109/10428194.2010.525724 |url=}}</ref>
+|Chronic
+|Months to years
+|Aching
+|Variable
+| -
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>+</nowiki>
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|Typically no specific lab findings, however, the following routine tests are performed;
+*CBC
+*Serum chemistry studies, including LDH
+*Serum beta2-microglobulin level
+*HIV serology
+|Radiography
+*May demonstrate hilar or mediastinal adenopathy
+*Pleural or [[pericardial effusion]]
+*Parenchymal involvement
+*Bulky mediastinal mass
+CT
+*May demonstrate enlarged lymph nodes
+*Hepatosplenomegaly
+*Filling defects in visceral organs
+Bone scan
+*Useful in those with elevated [[alkaline phosphatase]]
+Gallium scan
+*May show increased uptake
+MRI
+*Signal intensity changes are noted in those with bone marrow or muscular involvement
+PET - FDG
+*To distinguish between viable, active tumors and necrosis
+*To detect early recurrence
+Ultrasound
+*Useful if primary lesion is in testis
 |
-|
+*[[Hodgkin's lymphoma]] is usually focal and characterized by Reed-sternberg cells
-|
+*[[Non - hodgkin's lymphoma]] tends to be multifocal
-|
+*Biopsy provides ultimate diagnosis
-|
+|-
-|
+![[Multiple myeloma]]<ref name="pmid12528874">{{cite journal |vauthors=Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR |title=Review of 1027 patients with newly diagnosed multiple myeloma |journal=Mayo Clin. Proc. |volume=78 |issue=1 |pages=21–33 |date=January 2003 |pmid=12528874 |doi=10.4065/78.1.21 |url=}}</ref><ref name="pmid20194150">{{cite journal |vauthors=Turesson I, Velez R, Kristinsson SY, Landgren O |title=Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic |journal=Mayo Clin. Proc. |volume=85 |issue=3 |pages=225–30 |date=March 2010 |pmid=20194150 |pmc=2843108 |doi=10.4065/mcp.2009.0426 |url=}}</ref>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Pyomyositis]]
-|Acute or chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Rheumatoid arthritis]]
 |Chronic
 |Years
+|Dull aching
+|Hips, groin and legs
+| +/-
+| +/-
+| +/-
+| -
+| -
+| -
+| +/-
+| -
+| -
+| -
+| -
+| +/-
+| -
+|Serum protein [[electrophoresis]]
+*May demonstrate a M peak
+Serum free light chain assay and 24 - hour urine collection
+*May detect Bence-Jones proteins
+CRP
+*May be elevated
+Serum beta2-microglobulin
+*May be elevated
+Albumin
+*May demonstrate elevated [[albumin]] in urine
+LDH
+*May be elevated
+Peripheral blood smear
+*May demonstrate rouleaux formation > 50%
+*[[Leukopenia]]
+*[[Thrombocytopenia]]
+|Radiography, MRI and PET
+*Osteolytic lesions may be demonstrated
 |
+*Biopsy will demonstrate elevated plasma cells in the bone marrow
+|-
+![[Neurofibroma]]<ref name="pmid3582706">{{cite journal |vauthors=Banik R, Lubach D |title=Skin tags: localization and frequencies according to sex and age |journal=Dermatologica |volume=174 |issue=4 |pages=180–3 |date=1987 |pmid=3582706 |doi= |url=}}</ref>
+|Chronic<ref name="pmid17338704">{{cite journal |vauthors=Campbell LB, Petrick MG |title=Mohs micrographic surgery for a problematic infantile digital fibroma |journal=Dermatol Surg |volume=33 |issue=3 |pages=385–7 |date=March 2007 |pmid=17338704 |doi=10.1111/j.1524-4725.2007.33080.x |url=}}</ref><ref name="pmid8176009">{{cite journal |vauthors=Requena L, Fariña MC, Fuente C, Piqué E, Olivares M, Martín L, Sánchez Yus E |title=Giant dermatofibroma. A little-known clinical variant of dermatofibroma |journal=J. Am. Acad. Dermatol. |volume=30 |issue=5 Pt 1 |pages=714–8 |date=May 1994 |pmid=8176009 |doi= |url=}}</ref>
+|Weeks to years
+|Aching, pressure
+|Variable
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+| -
+|Molecular sequencing
+*Used to detect neurofibromin gene
+Urine analysis
+*Used to detect free [[catecholamine]] and their metabolites in suspected [[pheochromocytoma]]
+|Radiography
+*Bowing of bones
+*Medullary destruction
+MRI and CT
+*Used to determine neurologic pathologies
+*May demonstrate unidentified bright objects in brain scans
+*May demonstrate [[optic nerve]] and [[optic chiasma]] involvement
+*Bilateral [[acoustic neuroma]] is noted in [[neurofibromatosis]] type 2
+PET - FDG
+*Used to determine staging
 |
+*Marfanoid habitus may be noted in [[neurfibromatosis]] type 1
+|-
+![[Osteoblastoma]]<ref name="pmid8692589">{{cite journal |vauthors=Copley L, Dormans JP |title=Benign pediatric bone tumors. Evaluation and treatment |journal=Pediatr. Clin. North Am. |volume=43 |issue=4 |pages=949–66 |date=August 1996 |pmid=8692589 |doi= |url=}}</ref><ref name="pmid8272884">{{cite journal |vauthors=Greenspan A |title=Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations |journal=Skeletal Radiol. |volume=22 |issue=7 |pages=485–500 |date=October 1993 |pmid=8272884 |doi= |url=}}</ref><ref name="pmid1563167">{{cite journal |vauthors=Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R |title=Osteoblastoma of the spine |journal=Clin. Orthop. Relat. Res. |volume= |issue=278 |pages=37–45 |date=May 1992 |pmid=1563167 |doi= |url=}}</ref>
+|Chronic
+|Weeks to years
+|Dul aching
+|Variable
+| -
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
 |
+*Typically no specific lab findings are noted
+|Radiography
+*May demonstrate a well-circumscribed radiolucent tumor in cortex
+*Thin shell of peripheral new bone distinct from soft tissue
+*> 2cm in diameter
+*No associated reactive zone
+CT and MRI
+*May demonstrate size and extent of tumor relative to surrounding soft tissue
+Bone scan
+*Demonstrates cortical activity within the bone
+Angiography
+*Demonstrates the vascularity of the tumor
 |
-|
+*Presents in third decade of life
-|
+*Pain is not relieved by NSAIDs
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
+![[Osteoid osteoma]]<ref name="pmid850593">{{cite journal |vauthors=Orlowski JP, Mercer RD |title=Osteoid osteoma in children and young adults |journal=Pediatrics |volume=59 |issue=4 |pages=526–32 |date=April 1977 |pmid=850593 |doi= |url=}}</ref><ref name="pmid20225104">{{cite journal |vauthors=Wyers MR |title=Evaluation of pediatric bone lesions |journal=Pediatr Radiol |volume=40 |issue=4 |pages=468–73 |date=April 2010 |pmid=20225104 |doi=10.1007/s00247-010-1547-4 |url=}}</ref><ref name="pmid8692589">{{cite journal |vauthors=Copley L, Dormans JP |title=Benign pediatric bone tumors. Evaluation and treatment |journal=Pediatr. Clin. North Am. |volume=43 |issue=4 |pages=949–66 |date=August 1996 |pmid=8692589 |doi= |url=}}</ref>
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
+|Chronic
-! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
+|Years
-! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
+|Dull aching
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
+|Variable
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|Serum chemistry study
+*High levels of [[prostaglandin]] metabolites have been linked with [[osteoid osteoma]]s
+|Radiography
+*May demonstrate sclerosis around a radiolucent nidus
+CT
+*Demonstrates the margins of the nidus and calcifications present
+MRI
+*Useful only in a non-calcified nidus
+Radionuclide scan
+*Demonstrates increased uptake in diseased bone
+Arteriography
+*Used a last resort when other imaging has been unfruitful
+*Demonstrates 2 phases, early arterial phase, late arterial phase and venous phase
+|
+*Pain is relieved by use of NSAIDs
 |-
-! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
+![[Osteosarcoma]]<ref name="pmid16015627">{{cite journal |vauthors=Mialou V, Philip T, Kalifa C, Perol D, Gentet JC, Marec-Berard P, Pacquement H, Chastagner P, Defaschelles AS, Hartmann O |title=Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience |journal=Cancer |volume=104 |issue=5 |pages=1100–9 |date=September 2005 |pmid=16015627 |doi=10.1002/cncr.21263 |url=}}</ref><ref name="pmid1070715">{{cite journal |vauthors=Sissons HA |title=The WHO classification of bone tumors |journal=Recent Results Cancer Res. |volume= |issue=54 |pages=104–8 |date=1976 |pmid=1070715 |doi= |url=}}</ref><ref name="pmid13307660">{{cite journal |vauthors=CADE S |title=Osteogenic sarcoma; a study based on 133 patients |journal=J R Coll Surg Edinb |volume=1 |issue=2 |pages=79–111 |date=December 1955 |pmid=13307660 |doi= |url=}}</ref><ref name="pmid203202">{{cite journal |vauthors=Dahlin DC, Unni KK |title=Osteosarcoma of bone and its important recognizable varieties |journal=Am. J. Surg. Pathol. |volume=1 |issue=1 |pages=61–72 |date=March 1977 |pmid=203202 |doi= |url=}}</ref>
-! 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="9" align="center" style="background:#4479BA; color: #FFFFFF;" |Tumors
-![[Ewing's sarcoma]]
 |Chronic
+|Weeks to years
+|Severe, sharp
+|Variable
+|<nowiki>-</nowiki>
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+|<nowiki>-</nowiki>
 |
+*Typically no specific lab findings
+*Elevated [[LDH]] and [[alkaline phosphatase]] may suggest pulmonary metastasis
 |
+Radiography
+*May demonstrate an osteolytic or osteoblastic lesion
+*Elevation of the periosteum may be noted, and is known as "Codman's triangle"
+*Tumor spread to periosteum is known as "sunburst" sign
+CT
+*Chest CT is done to rule out pulmonary involvement
+*May also demonstrate the margins and extent of tumor
+MRI
+*Useful in detection of soft tissue involvement
+Bone scan
+*Increased uptake is noted in regions of metastasis
+*Technetium-99 - methylene diphosphonate is usually used
 |
+*Cardiac function should be assessed before the use of doxorubicin or daunorubicin
+|-
+![[Prostate cancer]]<ref name="pmid15960930">{{cite journal |vauthors=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX |title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage |journal=Clin Transl Oncol |volume=7 |issue=5 |pages=189–97 |date=June 2005 |pmid=15960930 |doi= |url=}}</ref><ref name="pmid1372943">{{cite journal |vauthors=Crawford ED, Schutz MJ, Clejan S, Drago J, Resnick MI, Chodak GW, Gomella LG, Austenfeld M, Stone NN, Miles BJ |title=The effect of digital rectal examination on prostate-specific antigen levels |journal=JAMA |volume=267 |issue=16 |pages=2227–8 |date=1992 |pmid=1372943 |doi= |url=}}</ref>
+|Chronic
+|Months to years
+|Severe, sharp
+|Lower abdomen, hips, groin and legs
+| -
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
+| -
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| +/-
+|<nowiki>-</nowiki>
+|[[PSA]]
+*Detection is helpful in diagnosis, usually > 10 ng/ml
+Acid and [[alkaline phosphatase]]
+*Useful in detecting metastasis
+Serurm creatinine and LFT
+*Useful in detecting metasstasis
+Urine analysis
+*May detect [[hematuria]] or infection
+|Ultrasound
+*Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity
+MRI
+*May be used to guide biopsy
 |
-|
+*PSA and DRE are gold standard for screening
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Langerhans cell histiocytosis]] (eosinophilic granulomas)
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
-|Chronic
+! 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
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Leukemia]]
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
-|Acute or chronic
+! 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
-|
-|
-|
-|
 |-
-![[Lymphoma]]
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Muscle-related
+![[Abnormal posturing]]<ref name="pmid16670549">{{cite journal |vauthors=Skaggs DL, Early SD, D'Ambra P, Tolo VT, Kay RM |title=Back pain and backpacks in school children |journal=J Pediatr Orthop |volume=26 |issue=3 |pages=358–63 |date=2006 |pmid=16670549 |doi=10.1097/01.bpo.0000217723.14631.6e |url=}}</ref><ref name="pmid9258304">{{cite journal |vauthors=Combs JA, Caskey PM |title=Back pain in children and adolescents: a retrospective review of 648 patients |journal=South. Med. J. |volume=90 |issue=8 |pages=789–92 |date=August 1997 |pmid=9258304 |doi= |url=}}</ref><ref name="pmid11097256">{{cite journal |vauthors=Feldman DS, Hedden DM, Wright JG |title=The use of bone scan to investigate back pain in children and adolescents |journal=J Pediatr Orthop |volume=20 |issue=6 |pages=790–5 |date=2000 |pmid=11097256 |doi= |url=}}</ref><ref name="pmid18388720">{{cite journal |vauthors=Bhatia NN, Chow G, Timon SJ, Watts HG |title=Diagnostic modalities for the evaluation of pediatric back pain: a prospective study |journal=J Pediatr Orthop |volume=28 |issue=2 |pages=230–3 |date=March 2008 |pmid=18388720 |doi=10.1097/BPO.0b013e3181651bc8 |url=}}</ref>
 |Chronic
+|Years
+|Dull aching
+|Shoulders, arms, hips, 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
 |
+*Typically no routine imaging done, diagnosed clinically
 |
+*Back brace maybe used with gentle exercise
+|-
+![[Muscle spasm]]<ref name="pmid28399251">{{cite journal |vauthors=Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, Branson R, Tang B, Morton SC, Shekelle PG |title=Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis |journal=JAMA |volume=317 |issue=14 |pages=1451–1460 |date=April 2017 |pmid=28399251 |pmc=5470352 |doi=10.1001/jama.2017.3086 |url=}}</ref><ref name="pmid16437495">{{cite journal |vauthors=French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ |title=Superficial heat or cold for low back pain |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD004750 |date=January 2006 |pmid=16437495 |doi=10.1002/14651858.CD004750.pub2 |url=}}</ref>
+|Acute
+|Days, weeks, months
+|Aching
+|Variable
+|<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 and ultrasound
+*May be utilized in non-resolution of muscle spasm to visualize the soft tissue
 |
+*Rest, bandaging and topical [[analgesic]]s are often used to treat
+|-
+!Pyriformis syndrome<ref name="pmid25574881">{{cite journal |vauthors=Cass SP |title=Piriformis syndrome: a cause of nondiscogenic sciatica |journal=Curr Sports Med Rep |volume=14 |issue=1 |pages=41–4 |date=January 2015 |pmid=25574881 |doi=10.1249/JSR.0000000000000110 |url=}}</ref><ref name="pmid23900507">{{cite journal |vauthors=Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J |title=Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome |journal=Surg Radiol Anat |volume=36 |issue=3 |pages=273–80 |date=April 2014 |pmid=23900507 |doi=10.1007/s00276-013-1180-7 |url=}}</ref>
+|Chronic
+|Years
+|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>
 |
+*Typically no specific lab findings
 |
+MRI and ultrasound
+*May be utilized in non-resolution of muscle spasm to visualize the soft tissue
 |
-|
+*Rest, bandaging and topical [[analgesic]]s are often used to treat
-|
+|-
-|
+! 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
 |-
-![[Neurofibroma]]
+! rowspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" |Miscellaneous
+![[Chronic fatigue syndrome]]<ref name="pmid16443043">{{cite journal |vauthors=Prins JB, van der Meer JW, Bleijenberg G |title=Chronic fatigue syndrome |journal=Lancet |volume=367 |issue=9507 |pages=346–55 |date=January 2006 |pmid=16443043 |doi=10.1016/S0140-6736(06)68073-2 |url=}}</ref><ref name="pmid1890495">{{cite journal |vauthors=Katon WJ, Buchwald DS, Simon GE, Russo JE, Mease PJ |title=Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis |journal=J Gen Intern Med |volume=6 |issue=4 |pages=277–85 |date=1991 |pmid=1890495 |doi= |url=}}</ref><ref name="pmid1951377">{{cite journal |vauthors=Lane TJ, Manu P, Matthews DA |title=Depression and somatization in the chronic fatigue syndrome |journal=Am. J. Med. |volume=91 |issue=4 |pages=335–44 |date=October 1991 |pmid=1951377 |doi= |url=}}</ref>
 |Chronic
+|Years
+|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>
 |
+*Typically no specific lab findings, however, serology may be somewhat specific and demonstrate;
+**Elevated IgM and/or IgG in [[coxsackie virus]] B titer
+**Elevated IgM and/or IgG [[human herpes virus]] 6 titer
+**Elevated IgM/IgG  in C pneumoniae titer
+**Decrease in [[natural killer cell]] percentage or activity
+*Labs used to exclude other pathologies include;
+CBC
+*May demonstrate [[leukopenia]] or [[leukocytosis]]
+LFT
+*May demonstrate elevated serum transaminases, [[alkaline phosphatase]], or [[lactic dehydrogenase]]
+TFT
+*To rule out hypo/[[hyperthyroidism]]
+ESR
+*Usually low
+Serum electrolytes
+*[[Hypokalemia]] or [[hypocalcemia]] may be noted
+[[ANA]]
+*May indicate an autoimmune disease
+[[Cortisol]]
+*May indicate pathology of the [[adrenal gland]]
+Serum protein [[electrophoresis]]
+*To rule out myeloma or [[lymphoma]]
+|CT and MRI
+*Used to exclude other pathologies
+PET
+*May demonstrate hypoperfusion of the frontoparietal and/or temporal region of the brain
 |
-|
+*Usually diagnosed by exclusion
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Osteoblastoma]]
+![[Depression]]<ref name="pmid24026579">{{cite journal |vauthors=Judd LL, Schettler PJ, Coryell W, Akiskal HS, Fiedorowicz JG |title=Overt irritability/anger in unipolar major depressive episodes: past and current characteristics and implications for long-term course |journal=JAMA Psychiatry |volume=70 |issue=11 |pages=1171–80 |date=November 2013 |pmid=24026579 |doi=10.1001/jamapsychiatry.2013.1957 |url=}}</ref><ref name="pmid26944392">{{cite journal |vauthors=van Dessel NC, van der Wouden JC, Dekker J, van der Horst HE |title=Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS) |journal=J Psychosom Res |volume=82 |issue= |pages=4–10 |date=March 2016 |pmid=26944392 |doi=10.1016/j.jpsychores.2016.01.004 |url=}}</ref><ref name="pmid26944392">{{cite journal |vauthors=van Dessel NC, van der Wouden JC, Dekker J, van der Horst HE |title=Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS) |journal=J Psychosom Res |volume=82 |issue= |pages=4–10 |date=March 2016 |pmid=26944392 |doi=10.1016/j.jpsychores.2016.01.004 |url=}}</ref>
 |Chronic
+|Months to years
+|Severe to mild aching
+|Variable
+|<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
+*Lab testing is used to diagnose organic causes and include;
+**[[CBC]]
+**TFT
+**Vitamin B-12 detection
+**[[Rapid plasma reagin]]
+**[[HIV]] testing
+**[[Electrolytes]], especially [[calcium]], [[phosphate]], and [[magnesium]] levels
+**[[BUN]] and [[creatinine]]
+**[[LFT]]s
+**Blood [[alcohol]] level
+**Blood and urine toxicology screen
+**[[ABG]]
+**[[Dexamethasone]] suppression test
+**Cosyntropin stimulation test
+|CT and MRI
+*To rule out organic brain syndrome or [[hypopituitarism]]
+PET
+*Allows for study of ligand-receptor binding
+SPECT
+*May demonstrate regional blood flow deficits in the left anterofrontal and temporal regions
 |
-|
+*Must assess suicidal ideation
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-![[Osteoid osteoma]]
+![[Dysmenorrhea]]<ref name="pmid25021">{{cite journal |vauthors=Ylikorkala O, Dawood MY |title=New concepts in dysmenorrhea |journal=Am. J. Obstet. Gynecol. |volume=130 |issue=7 |pages=833–47 |date=April 1978 |pmid=25021 |doi= |url=}}</ref><ref name="pmid7137249">{{cite journal |vauthors=Andersch B, Milsom I |title=An epidemiologic study of young women with dysmenorrhea |journal=Am. J. Obstet. Gynecol. |volume=144 |issue=6 |pages=655–60 |date=November 1982 |pmid=7137249 |doi= |url=}}</ref>
-|Chronic
+|Acute
-|
+|3 - 7 days
-|
+|Burning, dull aching or severe
-|
+|Groin, hips, legs
-|
+| -
-|
+|<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
+*Lab tests are done to rule out organic causes, and include;
+**CBC
+***Infection ([[leukocytosis]]) or malignancy
+**STD panel
+***[[Gonorrhea]], [[chlamydia]], and [[PID]]
+**Beta - Human chorionic gonadotropin
+***Elevated in [[pregnancy]]
+**ESR
+**Elevated in subacute [[salpingitis]]
+**Urine analysis
+**To rule out [[urinary tract infection]]
+**Stool guaiac test
+***To rule out gastrointestinal bleeding
+|Ultrasound
+*May reveal [[endometriosis]] as complex mass with specks
+*[[Ectopic pregnancy]]
+*Ovarian cysts
+*[[Fibroid]]s
+*Intrauterine contraceptive device
+Hysterosalpingography
+*May demonstrate [[endometrial polyp]]s
+*[[Leiomyoma]]s
+*Congenital abnormalities of the uterus
+IVP
+*May demonstrate a uterine malformation
+CT
+*May demonstrate [[ovarian torsion]]
+MRI
+*May detect [[adenomyosis]]
+*Submucous myomas
 |
+*[[Laparoscopy]], [[hysteroscopy]], and dilatation and curettage are useful in diagnosis and therapy
+|-
+![[Herpes zoster]]<ref name="pmid17143845">{{cite journal |vauthors=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ |title=Recommendations for the management of herpes zoster |journal=Clin. Infect. Dis. |volume=44 Suppl 1 |issue= |pages=S1–26 |date=January 2007 |pmid=17143845 |doi=10.1086/510206 |url=}}</ref><ref name="pmid15897984">{{cite journal |vauthors=Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF |title=Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002 |journal=J. Infect. Dis. |volume=191 |issue=12 |pages=2002–7 |date=June 2005 |pmid=15897984 |doi=10.1086/430325 |url=}}</ref><ref name="pmid8637540">{{cite journal |vauthors=Kost RG, Straus SE |title=Postherpetic neuralgia--pathogenesis, treatment, and prevention |journal=N. Engl. J. Med. |volume=335 |issue=1 |pages=32–42 |date=July 1996 |pmid=8637540 |doi=10.1056/NEJM199607043350107 |url=}}</ref>
+|Acute or chronic
+|Variable
+|Severe, stabbing, electric-like
+|Dermatomal
+| -
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+| +/-
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|[[Tzanck smear]]
+*May demonstrate multinucleated giant cells
+Direct fluorescent antibody test and/or [[PCR]]
+*Allows for differentiation between HSV and VZV
 |
+*Typically no routine imaging
+MRI
+*Used to exclude [[myelopathy]] or [[encephalopathy]]
+[[Lumbar puncture]] and [[cerebrospinal fluid]] analysis
+*In cases of suspected [[meningitis]], increased [[protein]] and [[pleocytosis]] will be noted
 |
+|-
+![[Pregnancy]]<ref name="pmid10819273">{{cite journal |vauthors=Foti T, Davids JR, Bagley A |title=A biomechanical analysis of gait during pregnancy |journal=J Bone Joint Surg Am |volume=82 |issue=5 |pages=625–32 |date=May 2000 |pmid=10819273 |doi= |url=}}</ref><ref name="pmid26714126">{{cite journal |vauthors=Bliddal M, Pottegård A, Kirkegaard H, Olsen J, Jørgensen JS, Sørensen TI, Dreyer L, Nohr EA |title=Association of Pre-Pregnancy Body Mass Index, Pregnancy-Related Weight Changes, and Parity With the Risk of Developing Degenerative Musculoskeletal Conditions |journal=Arthritis Rheumatol |volume=68 |issue=5 |pages=1156–64 |date=May 2016 |pmid=26714126 |doi=10.1002/art.39565 |url=}}</ref><ref name="pmid8783303">{{cite journal |vauthors=MacEvilly M, Buggy D |title=Back pain and pregnancy: a review |journal=Pain |volume=64 |issue=3 |pages=405–14 |date=March 1996 |pmid=8783303 |doi= |url=}}</ref><ref name="pmid8951013">{{cite journal |vauthors=Sanderson PL, Fraser RD |title=The influence of pregnancy on the development of degenerative spondylolisthesis |journal=J Bone Joint Surg Br |volume=78 |issue=6 |pages=951–4 |date=November 1996 |pmid=8951013 |doi= |url=}}</ref><ref name="pmid2521192">{{cite journal |vauthors=Weinreb JC, Wolbarsht LB, Cohen JM, Brown CE, Maravilla KR |title=Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women |journal=Radiology |volume=170 |issue=1 Pt 1 |pages=125–8 |date=January 1989 |pmid=2521192 |doi=10.1148/radiology.170.1.2521192 |url=}}</ref>
+|Chronic
+|Pregnancy term
+|Dull aching
+|Groin, hips, legs
+| +/-
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| -
+|<nowiki>-</nowiki>
+| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|Beta - human chorionic gonadotropin
+*If detected usually confirms [[pregnancy]]
 |
+*Typically no routine imaging is done to prevent radiation exposure, unless complication occurs an MRI may be carried out
 |
 |-
-![[Osteosarcoma]]
+![[Sickle cell anemia]]<ref name="pmid1710777">{{cite journal |vauthors=Platt OS, Thorington BD, Brambilla DJ, Milner PF, Rosse WF, Vichinsky E, Kinney TR |title=Pain in sickle cell disease. Rates and risk factors |journal=N. Engl. J. Med. |volume=325 |issue=1 |pages=11–6 |date=July 1991 |pmid=1710777 |doi=10.1056/NEJM199107043250103 |url=}}</ref><ref name="pmid7097407">{{cite journal |vauthors=Keeley K, Buchanan GR |title=Acute infarction of long bones in children with sickle cell anemia |journal=J. Pediatr. |volume=101 |issue=2 |pages=170–5 |date=August 1982 |pmid=7097407 |doi= |url=}}</ref><ref name="pmid8888755">{{cite journal |vauthors=Resar LM, Oliva MM, Casella JF |title=Skull infarction and epidural hematomas in a patient with sickle cell anemia |journal=J. Pediatr. Hematol. Oncol. |volume=18 |issue=4 |pages=413–5 |date=November 1996 |pmid=8888755 |doi= |url=}}</ref>
-|Chronic
+|Acute or chronic
-|
+|Variable
-|
+|Severe, sharp
-|
+|Variable
-|
+| +/-
-|
+|<nowiki>+</nowiki>
-|
+|<nowiki>+/-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+| -
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>-</nowiki>
-|
+|CBC
-|
-|
+*[[Hemoglobin]] level is between 5-9 g/dl
-|-
+*[[Hematocrit]] is decreased to 17-29%
-![[Prostate cancer]]
+*[[Leukocytosis]] with predominance of [[neutrophils]]
-|Chronic
+*[[Thrombocytopenia]]
-|
-|
+ESR
-|
-|
+*Decreased
-|
-|
+Reticulocyte count
-|
-|
+*Elevated
-|
-|
+Peripheral blood smear
-|
-|
+*May demonstrate [[target cell]]s, elongated cells, and sickle erythrocytes
-|
+*Howell - Jolly bodies in an asplenic patient
-|
-|
+[[Hemoglobin]] solubility
-|
-|
+*Distinguishes between [[sickle cell disease]] and [[sickle cell trait]]
-|
+Hemoglobin F
+*Percentage of [[Hemoglobin F]] is elevated
+LFT, [[renal function test]] and [[pulmonary function test]]
+*To assess organ distress or failure
+ABG
+*To detect [[oxygen saturation]]
+Urine analysis
+*May determine an [[urinary tract infection]] with hematuria and isosthenuria
+Sickling test
+*As screening for sickle hemoglobinopathies
+Secretory phospholipase A2
+*May be increased in acute chest syndrome, a complication of [[sickle cell disease]]
+|Radiography
+*Osteonecrosis
+*Dactylitis indicated by medullary expansion, cortical thinning, trabecular resorption, and bone lucency
+*Osteomyelitis may be present and demonstrate sequestra, cortical destruction, periosteal growth and sinus formation
+MRI and CT
+*In addition to findings in radiography, may detect [[bone marrow hyperplasia]]
+*May also be useful in ruling out renal medullary carcinoma in those presenting with [[hematuria]]
+Nuclear imaging
+*Used to detect  early osteonecrosis through Technetium-99m bone scanning
+*Used to detect early [[osteomyelitis]] through detection of elevation of[[white blood cell]]s in Indium-11 white blood cell scanning
+Transcranial doppler ultrasonography
+*Abnormally high blood flow is detected in those at increased risk of [[stroke]]
+Abdominal ultrasound
+*Used to exclude other pathologies such as, [[cholecystitis]], [[cholelithiasis]], [[ectopic pregnancy]], [[nephrolithiasis]], and [[papillary necrosis]]
+*May also be used to asses the size of the liver and spleen
+Echocardiography
+*Used to diagnose [[pulmonary hypertension]] based on tricuspid regurgitant jet velocity
+*Also used to assess abnormalities of systolic and diastolic function
 |
+*Sickle cell trait confers some protection against [[malaria]]
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
+![[Syringomyelia]]<ref name="pmid16676921">{{cite journal |vauthors=Milhorat TH |title=Classification of syringomyelia |journal=Neurosurg Focus |volume=8 |issue=3 |pages=E1 |date=March 2000 |pmid=16676921 |doi=10.3171/foc.2000.8.3.1 |url=}}</ref><ref name="pmid16549414">{{cite journal |vauthors=Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA |title=Ethnic differences in syringomyelia in New Zealand |journal=J. Neurol. Neurosurg. Psychiatry |volume=77 |issue=8 |pages=989–91 |date=August 2006 |pmid=16549414 |pmc=2077633 |doi=10.1136/jnnp.2005.081240 |url=}}</ref><ref name="pmid11807404">{{cite journal |vauthors=Larner AJ, Muqit MM, Glickman S |title=Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature |journal=Medicine (Baltimore) |volume=81 |issue=1 |pages=41–50 |date=January 2002 |pmid=11807404 |doi= |url=}}</ref>
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
+|Chronic
-! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
+|Years
-! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
+|Dull aching
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
+|Variable
+|<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
+*Of choice and demonstrates a syrinx (spinal cord cyst)
+*May also be useful in assessment of CSF flow dynamics
+Radiography and CT
+*May also visualize a syrinx
+Gadolinium scan
+*Useful in assessment of post-operative patients and can distinguish between a [[tumor]], [[scar]], and disk material
+Myelography
+*Used when MRI is unfruitful, and may detect widening of spinal cord and complete subarachnoid block
+|
 |-
-! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
+![[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>
-! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
+|Acute or chronic
-! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
+|Variable
-! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
+|Severe, sharp to dull aching
-|-
+|Variable
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness
+| +/-
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Rigors and chills
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Headache
+| +/-
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea and vomiting
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit
+|<nowiki>+/-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit
+|After establishment of first aid protocol, the following lab tests may be useful;
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur
+Pregnancy test
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
+*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
+|
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Muscle-related
+![[Ureteropelvic junction obstruction]] (UPJ)<ref name="pmid6842965">{{cite journal |vauthors=Klahr S |title=Pathophysiology of obstructive nephropathy |journal=Kidney Int. |volume=23 |issue=2 |pages=414–26 |date=February 1983 |pmid=6842965 |doi= |url=}}</ref><ref name="pmid12352365">{{cite journal |vauthors=McAleer IM, Kaplan GW, LoSasso BE |title=Congenital urinary tract anomalies in pediatric renal trauma patients |journal=J. Urol. volume=168 |issue=4 Pt 2 |pages=1808–10; discussion 1810 |date=October 2002 |pmid=12352365 |doi=10.1097/01.ju.0000028338.48621.57 |url=}}</ref><ref name="pmid11248635">{{cite journal |vauthors=Tekin A, Tekgul S, Atsu N, Ergen A, Kendi S |title=Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities |journal=Urology |volume=57 |issue=3 |pages=542–5; discussion 545–6 |date=March 2001 |pmid=11248635 |doi= |url=}}</ref>
-![[Abnormal posturing]]
+|Acute
-|Chronic
+|Hours to days
-|
+|Dull aching
-|
+|Groin, hips, 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>
+|CBC
+*To rule out [[anemia]]
+Coagulation profile
+*To rule out bleeding
+Electrolyte levels
+*To rule out [[nephrolithiasis]]
+BUN and serum creatinine
+*To assess kidney function
+Urine culture
+*To rule out [[urinary tract infection]]
+|Voiding cystourethrography
+*May demonstrate [[vesicoureteral reflux]]
+*Ostruction usually shows [[hydronephrosis]] without reflux
+Renal ultrasonography
+*May determine kidney malformation and scarring
+*Dilation of collecting system
+*Annular stricturing
+IVP
+*May demonstrate a hydronephrotic kidney
+*Used to map out entire urinary system
+CT and MRU
+*Provides detail about the urinary system such as;
+**Renal vasculature
+**Renal pelvis anatomy
+**Location of crossing vessels
+**Renal cortical scarring
+**Ureteral fetal folds in the proximal ureter
+Doppler
+*Used to detect cross vessels associated with obstruction
+MRA
+*May demonstrate aberrant renal vessels
 |
-|
+*Congenital abrnormalities in both children and adults are usually the cause of UPJ obstruction
-|
+|-
-|
+|}
-|
+</small></small>
-|
-|
+==References==
-|
+{{Reflist|2}}
-|
+{{WikiDoc Help Menu}}
-|
+{{WikiDoc Sources}}
-|
-|
-|-
-![[Muscle spasm]]
-|Acute
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-!Pyriformis syndrome
-|Chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-! 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="9" align="center" style="background:#4479BA; color: #FFFFFF;" |Miscellaneous
-![[Chronic fatigue syndrome]]
-|Chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Depression]]
-|Chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Herpes zoster]]
-|Acute or chronic
-|Variable
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Pregnancy]]
-|Chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Premenstrual syndrome]]
-|Acute
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Sickle cell anemia]]
-|Acute or chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Syringomyelia]]
-|Chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Physical trauma|Trauma]]
-|Acute or chronic
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-![[Ureteropelvic junction obstruction]]
-|Acute
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|}
-==References==
-{{Reflist|2}}
 [[Category:Pain]]
@@ Line 1,829: / Line 3,326: @@
 [[Category:Neurology]]
 [[Category:Emergency medicine]]
-[[Category:Primary care]]
 [[Category:Neurosurgery]]
 [[Category:Disease]]
-{{WikiDoc Help Menu}}
-{{WikiDoc Sources}}

Back pain differential diagnosis: Difference between revisions

Latest revision as of 14:21, 18 May 2021

Overview

Differential Diagnosis of Back Pain

References

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