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==
-===Life Threatening Causes===
+'''The following table outlines the major differential diagnoses of back pain.'''
-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 and bowel or bladder dysfunction, [[Back pain and bowel or bladder dysfunction|click here]]'''.''
-* [[Abnormal posturing]]
+'''''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]]'''.''
-* [[Degenerative disc disease]]
-* [[Depression]]
-* [[Osteoarthritis]]
-* [[Pregnancy]]
-* [[Premenstrual syndrome]]
-* [[Sciatica]]
-* [[Spinal disc herniation]]
-* [[Spinal stenosis]]
-* [[Trauma]]
+'''''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]]'''.''
-==Differential Diagnosis of Back Pain==
+'''''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]]'''.''
-'''The following table outlines the major differential diagnoses of back pain.'''
+'''''To review the differential diagnosis of back pain and stiffness, [[Back pain and stiffness|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 simplez virus, IVP = Intravenous pyelography, KUB = Kidney, bladder, ureter, LDH = Lactate dehydrogenase, LFT = Liver function test, MRC = Magnetic resonance cholangiopancreatography, MRI = Magnetic resonance imaging, NSAIDs = Non-steroidal anti-inflammatory drugs, PCR = Polymerase chain reaction, PET - FDG = Positive emission tomography - fluorodeoxyglucose, PET = Positive emission tomography, 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
+'''''To review the differential diagnosis of back pain and syncopy, [[Back pain and syncopy|click here]]'''.''
+'''''To review the differential diagnosis of back pain and weight loss, [[Back pain and weight loss|click here]]'''.''
+'''''To review the differential diagnosis of back pain exhibiting "red flags", [[Back pain 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, [[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 66: / 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 84: / Line 81: @@
 ! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Vascular
 ![[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>
-|Acute or subacute
+|[[Acute]] or [[subacute]]
 |Minutes to hours
 |Sharp and knife-like, also tearing or ripping
@@ Line 102: / Line 99: @@
 |<nowiki>-</nowiki>
 |
-Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
+Typically no specific lab findings, however, evidence of [[hemorrhage]] and organ injury may be seen in:
-* Complete blood count; normochromic normocytic anemia seen in haemorrhage
-* Elevated serum electrolytes
+*[[Complete blood count]]; [[normochromic normocytic anemia]] seen in [[hemorrhage]]
-* Elevated liver function tests
+*Elevated serum [[electrolytes]]
-* Elevated amylase or lipase
+*Elevated [[liver function tests]]
-|CT with IV contrast
+*Elevated [[amylase]] or [[lipase]]
-* May show venous delay and indicate renal trauma
+|[[CT]] with IV contrast
-Cystography
-* Should be considered in evaluation of hematuria and pelvic injury
+*May show venous delay and indicate renal trauma
+[[Cystography]]
+*Should be considered in evaluation of [[hematuria]] and pelvic injury
 |
-* Mostly caused by automobile accidents
+*Mostly caused by automobile accidents
 |-
 ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
@@ Line 127: / Line 128: @@
 ! 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 163: / Line 164: @@
 |<nowiki>+/-</nowiki>
 |CSF
-* Elevated protein with normal or low glucose
+*Elevated protein with normal or low [[glucose]]
 Culture and sensitivity
-* May be due to TB or Meningitis
+*May be due to [[TB]] or [[Meningitis]]
 Nucleic acid tests
-* Helpful in tuberculous meningitis
+*Helpful in tuberculous [[meningitis]]
 |Radiography
-* Thickened nerve roots
-CT
+*Thickened nerve roots
-* Narrowing of subarachnoid space
-* Irregular collections of contrast material
+[[CT]]
-* Thickened nerve roots
-MRI
+*Narrowing of subarachnoid space
-* Study of choice shows indistinct cord outline
+*Irregular collections of contrast material
+*Thickened nerve roots
+[[MRI]]
+*Study of choice shows indistinct cord outline
 |
-* Usually caused by meningitis or TB
+*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>
@@ Line 198: / Line 209: @@
 |<nowiki>-</nowiki>
 |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
+*To rule out [[anemia]]
-* Done to rule out acute denervation
+[[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
+*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>
@@ Line 238: / Line 266: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|CBC
+|[[CBC]]
-* May show leukocytosis, left shift, thrombocytopenia, and anemia
+*May show [[leukocytosis]], left shift, [[thrombocytopenia]], and [[anemia]]
 ESR
-* Elevated
+*Elevated
 Culture and sensitivity
-* To identify causative organism
+*To identify causative organism
 Immunohistochemical staining
-* Includes gram stain, special stains for fungi and mycobacteria, also consider brucella
+*Includes [[gram stain]], special stains for [[fungi]] and [[mycobacteria]], also consider [[brucella]]
 |MRI
-* Of choice and demonstrates fluid collection
+*Of choice and demonstrates fluid collection
 CT
-* Demonstrates fluid collection
+*Demonstrates fluid collection
 Radiography
-* Demonstrates osteomyelitis or vertebral collapse
+*Demonstrates [[osteomyelitis]] or vertebral collapse
 |
-* LP carries risk of spread of infection
+*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>
@@ Line 274: / Line 313: @@
 |<nowiki>-</nowiki>
 |
-* Typically no specific lab findings
+*Typically no specific lab findings
 |
 Radiography
-* To rule out serious underlying etiology
+*To rule out serious underlying etiology
 CT
-* Demonstrates disc herniation
+*Demonstrates [[disc herniation]]
 MRI
-* Demonstrates disc herniation and nerve root impingement
+*Demonstrates [[disc herniation]] and nerve root impingement
 Myelography
-* Used preoperatively to visualize spinal anatomy accurately
+*Used preoperatively to visualize spinal anatomy accurately
 Discography
-* To localize a symptomatic disc
+*To localize a symptomatic disc
 |
-*Disc herniation is the most common cause of nerve impingement
+*[[Disc herniation]] is the most common cause of nerve impingement
 |-
 ![[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>
@@ Line 308: / Line 356: @@
 |<nowiki>-</nowiki>
 |To exclude other pathologies
-* CBC with differential
-* ESR
+*[[CBC]] with differential
-* Alkaline and acid phosphatase level
+*[[ESR]]
-* Serum calcium level
+*Alkaline and acid phosphatase level
-* Serum protein electrophoresis
+*Serum [[calcium]] level
+*Serum [[protein]] electrophoresis
 |
 Radiography
-* With technetium-99m labeled phosphorus to indicate bone mineralization status
+*With technetium-99m labeled [[phosphorus]] to indicate bone mineralization status
 CT
-* Demonstrates disc herniation
+*Demonstrates [[disc herniation]]
 MRI
-* Demonstrates disc herniation and nerve root impingement
+*Demonstrates [[disc herniation]] and nerve root impingement
 Myelography
-* Used preoperatively to visualize spinal anatomy accurately
+*Used preoperatively to visualize spinal anatomy accurately
 Discography
-* To localize a symptomatic disc
+*To localize a symptomatic disc
 |
 *May have a psychological component
 |-
 ![[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>
@@ Line 351: / Line 409: @@
 |<nowiki>-</nowiki>
 |Neoplasm must be suspected and is ruled out by
-** CBC - May demonstrate a pancytopenia
-** Prothrombin time and activated partial thromboplastin time - May be prolonged
+**CBC - May demonstrate a [[pancytopenia]]
-** Metabolic profile, including calcium level and liver function - May indicate metastasis
+**[[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
+*May demonstrate tumors and collapse of intervertebral spaces
+*May distinguish between bone lesions and malignancy
 Radiography
-* May demonstrates bony destruction or calcification
+*May demonstrates bony destruction or [[calcification]]
 Nuclear imaging
-* To identify neoplasms
+*To identify neoplasms
 |
 *Aggressive radiotherapy is often needed
@@ Line 377: / 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 413: / Line 477: @@
 |<nowiki>-</nowiki>
 |
-* Typically no specific lab findings
+*Typically no specific lab findings
 |MRI
-* Demonstrates both inflammatory and structural lesions
+*Demonstrates both inflammatory and structural lesions
 CT
-* Useful in identifying structural lesions
+*Useful in identifying structural lesions
 Radiography
-* Useful in identifying structural lesions
+*Useful in identifying structural lesions
 Doppler ultrasound
-* To detect active esthesitis
+*To detect active esthesitis
 |
 Extra-articular manifestations are common and include
-* Uveitis
-* CVD
+*[[Uveitis]]
-* Respiratorydisease
+*CVD
-* Renal disease
+*Respiratory disease
-* Neurologic disease
+*Renal disease
-* GI disease
+*Neurologic disease
-* Metabolic bone disease
+*GI disease
+*Metabolic bone disease
 Often affecting a young male
 |-
@@ Line 452: / Line 525: @@
 |<nowiki>-</nowiki>
 |
-* Typically no specific lab findings
+*Typically no specific lab findings
 |
 MRI
-* Of choice and demonstrates transitional vertebra
+*Of choice and demonstrates transitional vertebra
 CT
-* Demonstrates vertebral transition
+*Demonstrates vertebral transition
 Radiography
-* Demonstrates vertebral transition
+*Demonstrates vertebral transition
 |
-* Congenital anomaly and may be asymptomatic
+*Congenital anomaly and may be asymptomatic
 |-
 ![[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>
@@ Line 481: / Line 559: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|CBC
+|[[CBC]]
-* Leukocytosis and left shift
+*[[Leukocytosis]] and left shift
-ESR
-* Elevated
+[[ESR]]
-CRP
-* Elevated
+*Elevated
-Procalcitonin
-* Elevated
+[[CRP]]
+*Elevated
+[[Procalcitonin]]
+*Elevated
 Culture and sensitivity
-* To identify causative agent
+*To identify causative agent
 |Radiography
-* Demonstrates endosteal or medullary lesion
-* Sequestration and cavity formation
+*Demonstrates endosteal or medullary lesion
+*Sequestration and cavity formation
 MRI
-* Bone marrow abnormalities and lytic changes
+*[[Bone marrow]] abnormalities and lytic changes
 CT
-* Articular and periarticular involvement
+*Articular and periarticular involvement
 Ultrasound
-* Soft tissue abnormalities
+*Soft tissue abnormalities
 Nuclear imaging
-* Loss of bone density
+*Loss of [[bone density]]
 |
 *Acute presentation is often seen in children and is associated with gait abnormalities
@@ Line 527: / Line 622: @@
 |Radiography
-*May demonstrate fracture of the vertebrae and/or preexisting pathology that may have lead to fracture
+*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
 |
@@ Line 554: / Line 654: @@
 |<nowiki>+/-</nowiki>
 |Serology
-*HLA-B27 may be positive or negative
-*IgA may be elevated
+*[[HLA-B27]] may be positive or negative
-*ANA may be positive
+*[[IgA]] may be elevated
-*Rheumatoid factor may be positive
+*[[ANA]] may be positive
-CBC
+*[[Rheumatoid factor]] may be positive
-*May indicate anemia
-ESR
+[[CBC]]
+*May indicate [[anemia]]
+[[ESR]]
 *May be elevated
-CRP
+[[CRP]]
 *May be elevated
-Uric acid
+[[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
+*Controversial, demonstrates [[disc herniation]]
 |
-*Transforaminal selective nerve root blocks are used diagnostically and therapeutically in cases presenting with radicular pain
+*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>
@@ Line 597: / Line 711: @@
 *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
+*Useful in lateral herniations with [[calcification]]
 Radiography
-*Demonstrates osteophytes, disc-space narrowing, and kyphosis
+*Demonstrates osteophytes, disc-space narrowing, and [[kyphosis]]
 Discography
 *Controversial, may show endplate irregularites or annular tears
 |
@@ Line 625: / Line 746: @@
 |<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
-|CBC
+|[[CBC]]
-*May demonstrate leukocytosis
+*May demonstrate [[leukocytosis]]
-ESR
+[[ESR]]
 *May be elevated
-CRP
+[[CRP]]
 *May be elevated
-Procalcitonin
+[[Procalcitonin]]
 *May be elevated
 Culture and sensitivity
 *To identify causative agent
-|MRI
+|[[MRI]]
-*Narrowing of disk space and low signalling indicates edema
+*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
+[[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
+*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
 |
@@ Line 667: / Line 802: @@
 *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
+*Arcuate [[kyphosis]]
 |
-*Often begins as loss of height with normal aging
+*Often begins as loss of height with normal [[aging]]
 |-
 ![[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
@@ Line 693: / Line 829: @@
 |<nowiki>-</nowiki>
 |ESR
-* Elevated
+*Elevated
 CRP
-* Elevated
+*Elevated
 Synovial fluid analysis
-* WBCs < 2000/mm3
-* Polys < 25%
+*WBCs < 2000/mm3
-* Culture negative
+*Polys < 25%
-* Crystal negative
+*Culture negative
-* Elevated IL-2, IL-5, MCP-1
+*Crystal negative
+*Elevated IL-2, IL-5, MCP-1
 |Radiography
-* Asymmetric joint space narrowing
-* Subchondral sclerosis
+*Asymmetric joint space narrowing
-* Subchondral cysts
+*Subchondral sclerosis
+*Subchondral cysts
 MRI
-* Joint space narrowing
-* Degeneration
+*Joint space narrowing
+*Degeneration
 |
-* Gradual onset
+*Gradual onset
-* Polyarthritis
+*Polyarthritis
-* Hips, knees, distal and proximal interphalyngeal joints and spine involvement
+*Hips, knees, distal and proximal interphalyngeal joints and spine involvement
-* Bouchard's and Heberden's  nodes
+*Bouchard's and Heberden's nodes
 |-
 !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>
@@ Line 734: / Line 878: @@
 |<nowiki>-</nowiki>
 |CBC
-*May show leukocytosis
+*May show [[leukocytosis]]
 ESR
 *May be elevated
 CRP
 *May be elevated
 Serology
-*ANA
-*Rheumatoid factor
+*[[ANA]]
-*HLA-B27
+*[[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
+*Used primarily to exclude [[disc herniation]]
 Nuclear imaging
 *Used to rule out stress fractures and metastatic bone disease
 |
-*Rehabilitation is often sought
+*[[Rehabilitation]] is often sought
 |-
 !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>
@@ Line 775: / Line 933: @@
 |<nowiki>-</nowiki>
 |CBC
-*May demonstrate leukocytosis
+*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
+*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
+*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
 |
@@ Line 816: / Line 990: @@
 *Typically no specific lab findings
 |Radiography
 *Wedge-shaped vertebra
-*Arcuate kyphosis
+*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)
+*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
@@ Line 845: / Line 1,020: @@
 *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
+*Used to assess additional complaints such as [[headache]]s, not routine for adolescents
 |
-*Most commonly is idiopathic
+*Most commonly is [[idiopathic]]
 |-
 ![[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>
@@ Line 872: / Line 1,050: @@
 *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
 |
@@ Line 900: / Line 1,081: @@
 *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
 |
@@ Line 909: / Line 1,095: @@
 |-
 ![[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>
 |Acute
 |Minutes to hours
 |Sudden, severe, sharp
@@ Line 927: / Line 1,113: @@
 |<nowiki>-</nowiki>
 |CBC
-*Decreased hematocrit and anemia
-PSA
+*Decreased [[hematocrit]] and [[anemia]]
-*To rule out prostatic cancer
+[[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
+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
+*To distinguish benign from malignant causes of compression
 |
 *Presents as a midline back pain
 |-
 ![[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>
@@ Line 969: / Line 1,173: @@
 |<nowiki>-</nowiki>
 |CBC
-* Leukocytosis and left shift
+*[[Leukocytosis]] and left shift
 ESR
-* Elevated
+*Elevated
 CRP
-* Elevated
+*Elevated
 Procalcitonin
-* Elevated
+*Elevated
 Culture and sensitivity
-* To identify causative agent
+*To identify causative agent
 |Radiography
-* Demonstrates endosteal or medullary lesion
-* Sequestration and cavity formation
+*Demonstrates endosteal or medullary lesion
+*Sequestration and cavity formation
 MRI
-* Bone marrow abnormalities and lytic changes
+*[[Bone marrow]] abnormalities and lytic changes
 CT
-* Articular and periarticular involvement
+*Articular and periarticular involvement
 Ultrasound
-* Soft tissue abnormalities
+*Soft tissue abnormalities
 Nuclear imaging
-* Loss of bone density
+*Loss of bone density
 |
 *Often caused by hematogenous spread of organism
@@ Line 1,005: / Line 1,227: @@
 ! 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 1,045: / Line 1,267: @@
 |<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
+*Complete blood count; normochromic normocytic anemia seen in haemorrhage
-* Elevated liver function tests
+*Elevated serum electrolytes
-* Elevated amylase or lipase
+*Elevated [[liver function test]]s
+*Elevated [[amylase]] or [[lipase]]
 |Ultrasonography
-* Visualization of aneurysm, size and/or rupture and hematoma
+*Visualization of aneurysm, size and/or rupture and hematoma
 Chest radiography
-* Visualizes calcifications in aneurysm but not specific
+*Visualizes calcifications in aneurysm but not specific
 CT
-* Demonstrates aortic size, extent, and involvement of organ arteries
+*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
+*Has advantage of less radiation and no use for dye, whilst demonstrating same findings as [[ultrasound]] and [[CT]]
-* Allows 3D construction of aorta
-Echocardiography (Transesophageal)
+[[Angiography]]
-* Demonstrates fluid shift and need for cardiology intervention
+*Allows 3D construction of aorta
+[[Echocardiography]] (Transesophageal)
+*Demonstrates fluid shift and need for cardiology intervention
 |
-* Livedo reticularis may be seen and indicates thrombotic phenomenon
+*[[Livedo reticularis]] may be seen and indicates thrombotic phenomenon
 |-
 ![[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>
@@ Line 1,083: / Line 1,317: @@
 |<nowiki>-</nowiki>
 |Elevations in:
-* D - dimer
-* Smooth muscle myosin heavy chain
+*[[D - dimer]]
-* Soluble ST2
+*Smooth muscle myosin heavy chain
-* Soluble elastin fragments
+*Soluble ST2
-* High -sensitivity C-reactive protein
+*Soluble elastin fragments
-* Fibrinogen
+*High -sensitivity C-reactive protein
-* Fibrillin fragments
+*[[Fibrinogen]]
+*Fibrillin fragments
 |ECG:
-* Normal
-* Non - specific ST wave changes
+*Normal
-* Hypertrophy patterns
+*Non - specific ST wave changes
-* ST segment elevation indicating myocardial infarction
+*Hypertrophy patterns
+*ST segment elevation indicating myocardial infarction
 Chest radiography:
-* Normal
-* Mediastinal or aortic widening
+*Normal
+*Mediastinal or aortic widening
 |
-* Increased risk of occurence with Marfan syndrome
+*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>
@@ Line 1,121: / Line 1,358: @@
 |<nowiki>-</nowiki>
 |CBC
-*Demonstrates leukocytosis and neutrophilia
+*Demonstrates [[leukocytosis]] and [[neutrophilia]]
 CRP
 *May be elevated
 Urine analysis
-*May demonstrate pyuria, hematuria, and/or proteinuria
+*May demonstrate [[pyuria]], [[hematuria]], and/or [[proteinuria]]
 Urine 5-HIAA
-*Maybe an early marker of appendictis
-*Sudden increase may indicate necrosis
+*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
+*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
+[[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
+*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>
@@ Line 1,164: / Line 1,419: @@
 |<nowiki>-</nowiki>
 |CBC
-*Demonstrates polymorphnuclear leukocytosis
+*Demonstrates polymorphnuclear [[leukocytosis]]
 LFT
-*Elevated alanine aminotransferase and aspartate aminotransferases
-*Elevated conjugated bilirubin
+*Elevated [[alanine aminotransferase]] and [[aspartate aminotransferases]]
-Amylase and lipase
+*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
+*May indicate presence of [[gallstones]] in the distal [[common bile duct]]
 MRI
-**May indicate presence of gallstones in the distal common bile duct
+**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
+*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
@@ Line 1,201: / Line 1,474: @@
 |<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
+*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
+*Normal, may show [[calcification]] or complications such as [[pleural effusion]]
 Exercise stress testing
-* Establishes diagnosis and extent of angina
+*Establishes diagnosis and extent of [[angina]]
 Stress Echo
-* To evaluate wall motion, normal in stable angina
+*To evaluate wall motion, normal in [[stable angina]]
 Nuclear imaging
-* To assess myocardial perfusion, reduced in stable angina
+*To assess myocardial perfusion, reduced in [[stable angina]]
 CT
-* To evaluate coronary artery calcium (cac) which may or may not be elevated
+*To evaluate coronary artery calcium (cac) which may or may not be elevated
 CT Angiography
-* To evaluate stenosis, <70% in stable angina
+*To evaluate [[stenosis]], <70% in [[stable angina]]
 EKG
-* Normal in stable angina
+*Normal in [[stable angina]]
 |
-* Hallmark is relief by rest or sublingual nitroglycerin
+*Hallmark is relief by rest or sublingual [[nitroglycerin]]
 |-
 ![[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>
@@ Line 1,244: / Line 1,531: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 ||Urine analysis
-*May demonstrate pyuria, hematuria, white blood cell casts and proteinuria
+*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
+*May demonstrate [[leukocytosis]] and/or [[anemia]]
 |
 *Typically no routine imaging done
 |
 *Cystitis may be infectious, hemorrhagic, radiational, or sterile
 |-
 ![[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>
@@ Line 1,276: / Line 1,568: @@
 |<nowiki>-</nowiki>
 |CBC
-*Anemia and leukocytosis may be noted
+*[[Anemia]] and [[leukocytosis]] may be noted
 Serology
-*Decrease C3, C4, and CH50 may indicate subacute endocarditis
-*Rheumatoid factor may be positive
+*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
+*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
+*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
+*IV drug users and those who suffer from [[rheumatic heart disease]] often present with [[infective endocarditis]]
 |-
 ![[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>
@@ Line 1,317: / Line 1,623: @@
 |<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
-*May indicate cause is rheumatoid arthritis
+[[Rheumatoid factor]] and/or anti-cyclic citrullinated peptide antibodies
+*May indicate cause is [[rheumatoid arthritis]]
 CRP and ESR
-*May be elevated
+*May be elevated
 CBC
-*May indicate anemia
+*May indicate [[anemia]]
 Bone profile
-*May be caused by a vitamin D or calcium deficiencyDipstick urinalysis
+*May be caused by a [[vitamin D]] or calcium deficiency
 |
 *Typically no routine imaging done
 |
-*May be associated with Hepatitis C and Lyme disease
+*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>
@@ Line 1,350: / Line 1,665: @@
 |<nowiki>-</nowiki>
 |CBC
-*Mild leukocytosis may indicate infection
+*Mild [[leukocytosis]] may indicate infection
 Electrolytes
-*Hypokalemia may indicate acute tubular necrosis
-*Hypercalcemia or hypercalciuria may be detected
+*[[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
+*[[Uric acid]] stones sometimes occur with gout
 ABG
-*May indicate  acute tubular necrosis with hypokalemia and decreased bicarbonate
+*May indicate  [[acute tubular necrosis]] with [[hypokalemia]] and decreased bicarbonate
 |CT
-*Visualizes calcium stones and other possible pathologies, such as hydronephrosis
+*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 ureteral calculi visualization
+*Particularly useful for ureteric calculi visualization
 Nuclear renal imaging
 *May determine a decreased renal function
 |
-*Hypercalcemia may indicate primary or secondary hyperparathyroidism
+*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>
@@ Line 1,396: / Line 1,733: @@
 |<nowiki>-</nowiki>
 |Amylase and lipase
 *Elevated
 LFT
-*Elevated alkaline phosphatase, total bilirubin, aspartate aminotransferase, and alanine aminotransferase
+*Elevated [[alkaline phosphatase]], total [[bilirubin]], [[aspartate aminotransferase]], and [[alanine aminotransferase]]
 CBC
-*May demonstrate leukocytosis
+*May demonstrate [[leukocytosis]]
 Serum electrolytes
-*May indicate hypo or hypercalcemia
+*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
+*[[Pancreas]] may appear enlarged
 MRC
 *May demonstrate a blockage within the biliary ducts
 ERCP
-*May remove a blockage, however, can in fact cause pancreatitis
+*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
+*Usually caused by binge drinking or long standing gallstones that block the [[ampulla of Vater]]
-*Vomiting is a common manifestation
+*[[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>
@@ Line 1,441: / Line 1,798: @@
 |<nowiki>-</nowiki>
 |CBC
-*Leukocytosis, may indicate infection with trichomoniasis
+*[[Leukocytosis]], may indicate infection with [[trichomoniasis]]
 Pregnancy test
-*To rule out ectopic pregnancy
+*To rule out [[ectopic pregnancy]]
 STD panel
-*To rule out gonorrhea, chlamydia, hepatitis B and C, HIV, and syphilis
+*To rule out [[gonorrhea]], [[chlamydia]], [[hepatitis B]] and C, [[HIV]], and [[syphilis]]
 Urine analysis
-*To rule out a urinary tract infection
+*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
+*May demonstrate adhesions (Asherman's syndrome) or gun powder lesions ([[Endometriosis]]) or an [[ectopic pregnancy]]
 MRI and CT
 *May indicate hydro and/ or pyosalpinx
 |
@@ Line 1,462: / Line 1,831: @@
 |Severe, sharp
 |Chest and back
-|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 1,476: / Line 1,845: @@
 |<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
+*[[Antithrombin]] III deficiency
-** Lupus
+*[[Protein C]]or [[protein S]] deficiency
-** Homocystinuria
+*[[Lupus]]
-** Malignancy
+*Homocystinuria
-** Connective tissue disorders
+*Malignancy
+*Connective tissue disorders
 |
-* D - dimer is positive and ventilation- perfusion scanning will show a a perfusion/ventilation mismatch
+*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
+*CT Angiography and duplex angiography are able to visualize the embolism
 |
-* PE may occur even in patients that are fully anticoagulated
+*PE may occur even in patients that are fully anticoagulated
-* DVT is a common source
+*[[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>
@@ Line 1,505: / Line 1,875: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |CRP
 *Elevated
 ESR
 *Elevated
 Urinalysis
-*Pyuria
+*[[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
+*Culture positibe (Uncomplicated: E. coli, [[Proteus mirabialis]], Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis
 |Ultrasound
-*Hydronephrosis
+*[[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
+*[[Pregnancy]]
 *Prolonged urinary catheterization
 |-
@@ Line 1,550: / Line 1,930: @@
 |<nowiki>-</nowiki>
 |CBC
-*Leukocytosis is often demonstrated however, white blood cell count may be normal
+*[[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
 |
@@ Line 1,579: / Line 1,965: @@
 |<nowiki>-</nowiki>
 |CBC
-*Demonstrates leukocytosis
+*Demonstrates [[leukocytosis]]
 ESR
-*Elevated
-Serum creatine kinase and aldolase
+*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
+*Can differentiate between [[osteomyelitis]] and pyomyositis by demonstrating early muscle inflammation or abscess formation
 CT
-*May demonstrate hypertrophy of muscles and/or effacement of fatty plane
+*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
+*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
@@ Line 1,619: / Line 2,021: @@
 |<nowiki>-</nowiki>
 |ESR and CRP
 *Elevated
 CBC
-*May indicate anemia
-Rheumatoid factor
+*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 rhuematoid arthritis
+*Are specific to [[rheumatoid arthritis]]
 |Radiography
-*Osteopenia is noted
+*[[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
@@ Line 1,659: / Line 2,075: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
+|Typically no specific lab findings, however, evidence of [[hemorrhage]] and organ injury may be seen in:
-* Complete blood count; normochromic normocytic anemia seen in haemorrhage
-* Elevated serum electrolytes
+*Complete blood count; [[normochromic normocytic anemia]] seen in [[hemorrhage]]
-* Elevated liver function tests
+*Elevated serum electrolytes
-* Elevated amylase or lipase
+*Elevated liver function tests
+*Elevated [[amylase]] or [[lipase]]
 |Ultrasonography
-* Visualization of rupture, size and hematoma
+*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
+*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
+*Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT
 Angiography
-* Allows 3D construction of aorta
+*Allows 3D construction of aorta
 Echocardiography (Transesophageal)
-* Demonstrates fluid shift and need for cardiology intervention
+*Demonstrates fluid shift and need for cardiology intervention
 |
-* Mostly caused by automobile accidents
+*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>
@@ Line 1,696: / Line 2,122: @@
 |<nowiki>-</nowiki>
 |CBC
-* May show decreased hemotocrit, leukocytosis and rarely, eosinophilia
+*May show decreased [[hemotocrit]], [[leukocytosis]] and rarely, [[eosinophilia]]
 Serum electrolytes
-* Hyponatremia
-* Hyperkalemia
+*[[Hyponatremia]]
-* Hypercalcemia
+*[[Hyperkalemia]]
-Blood urea nitrogen
+*[[Hypercalcemia]]
-* Elevated
-Creatinine
+[[Blood urea nitrogen]]
-* Elevated
+*Elevated
+[[Creatinine]]
+*Elevated
 Plasma glucose
-* Hypoglycemia
-Serum cortisol
+*[[Hypoglycemia]]
-* Decreased
-Plasma ACTH,
+Serum [[cortisol]]
-* Elevated
+*Decreased
+Plasma [[ACTH]]
+*Elevated
 |CT
-* Shows adrenal enlargement or adrenal aymmetry
+*Shows adrenal enlargement or adrenal aymmetry
 |
-* Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis
+*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
@@ Line 1,729: / Line 2,169: @@
 ! 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 1,767: / Line 2,207: @@
 Tests are used to rule out other pathologies;
 CBC
-*May indicate anemia
+*May indicate [[anemia]]
 Blood cultures
 *May be positive for various organisms
 ESR and CRP
-*May be elvated
+*May be elevated
 LDH
 *May be elevated
 Cytogenetic studies
-* May be positive for t(11;22) translocation
+*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
 |
@@ Line 1,810: / Line 2,266: @@
 |Tests used to rule out other pathologies;
 CBC
-*Reticulocyte count may be increased
-*Positive or negative direct and indirect Coombs test
+*[[Reticulocyte]] count may be increased
-*Immunoglobulin levels may be elevated
+*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
+*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
+*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
 |
@@ Line 1,849: / Line 2,319: @@
 |<nowiki>-</nowiki>
 |CBC
-*Mature or immature leukocytosis
+*Mature or immature [[leukocytosis]]
 Coagulation study
-*May demonstrate elevated prothrombin time, decreasing fibrinogen level, and presence of fibrin split products
+*May demonstrate elevated[[ prothrombin time]], decreasing [[fibrinogen]] level, and presence of fibrin split products
 Peripheral blood smear
-*May demonstrate blasts, schistocytes, auer rods, and mature lymphocytosis
+*May demonstrate blasts, ppschistocyte]]s, auer rods, and mature [[lymphocytosis]]
 Blood chemistry profile
-*May demonstrate tumor lysis syndrome through elevated LDH and uric acid
+*May demonstrate [[tumor lysis syndrome]] through elevated [[LDH]] and [[uric acid]]
 Blood culture
 *To rule out infection
 |
@@ Line 1,882: / Line 2,361: @@
 |<nowiki>-</nowiki>
 |Typically no specific lab findings, however, the following routine tests are performed;
 *CBC
 *Serum chemistry studies, including LDH
@@ Line 1,887: / Line 2,367: @@
 *HIV serology
 |Radiography
 *May demonstrate hilar or mediastinal adenopathy
-*Pleural or pericardial effusion
+*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
+*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
+*[[Hodgkin's lymphoma]] is usually focal and characterized by Reed-sternberg cells
-*Non - hodgkin's lymphoma tends to be multifocal
+*[[Non - hodgkin's lymphoma]] tends to be multifocal
 *Biopsy provides ultimate diagnosis
 |-
-![[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>
+![[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>
-|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>
+|Chronic
-|Weeks to years
+|Years
-|Aching, pressure
+|Dull aching
-|Variable
+|Hips, groin and legs
-|<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
 | -
 | -
+| +/-
 | -
+|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>
-|<nowiki>-</nowiki>
+| -
-|<nowiki>-</nowiki>
+| -
-|<nowiki>-</nowiki>
+|Molecular sequencing
-|<nowiki>-</nowiki>
-|
+*Used to detect neurofibromin gene
-*Typically no specific lab findings are noted
-|Radiography
+Urine analysis
-*May demonstrate a well-circumscribed radiolucent tumor in cortex
-*Thin shell of peripheral new bone distinct from soft tissue
+*Used to detect free [[catecholamine]] and their metabolites in suspected [[pheochromocytoma]]
-*> 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]]<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>
-|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>
-|<nowiki>-</nowiki>
-|Serum chemistry study
-*High levels of prostaglandin metaboliteshave been linked with osteoid osteomas
 |Radiography
-*May demonstrate sclerosis around a radiolucent nidus
-CT
+*Bowing of bones
-*Demonstrates the margins of the nidus and calcifications present
+*Medullary destruction
-MRI
-*Useful only in a non-calcified nidus
+MRI and CT
-Radionuclide scan
-*Demonstrates increased uptake in diseased bone
+*Used to determine neurologic pathologies
-Arteriography
+*May demonstrate unidentified bright objects in brain scans
-*Used a last resort when other imaging has been unfruitful
+*May demonstrate [[optic nerve]] and [[optic chiasma]] involvement
-*Demonstrates 2 phases, early arterial phase, late arterial phase and venous phase
+*Bilateral [[acoustic neuroma]] is noted in [[neurofibromatosis]] type 2
+PET - FDG
+*Used to determine staging
 |
-*Pain is relieved by use of NSAIDs
+*Marfanoid habitus may be noted in [[neurfibromatosis]] type 1
 |-
-![[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>
+![[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
-|Severe, sharp
+|Dul aching
 |Variable
-|<nowiki>-</nowiki>
+| -
 | -
 | -
@@ Line 2,027: / Line 2,511: @@
 |<nowiki>-</nowiki>
 | -
-| -
-| -
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-| -
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |
-*Typically no specific lab findings
+*Typically no specific lab findings are noted
-*Elevated LDH and alkaline phosphatase may suggest pulmonary metastasis
+|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
 |
-Radiography
+*Presents in third decade of life
-*May demonstrate an osteolytic or osteoblastic lesion
+*Pain is not relieved by NSAIDs
-*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
 |-
-![[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>
+![[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>
 |Chronic
 |Years
 |Dull aching
-|Hips, groin and legs
+|Variable
-| +/-
-| +/-
-| +/-
 | -
-| -
-| -
-| +/-
-| -
-| -
-| -
-| -
-| +/-
-| -
-|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
-|-
-![[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>
 |<nowiki>-</nowiki>
-|PSA
+|<nowiki>-</nowiki>
-*Detection is helpful in diagnosis, usually > 10 ng/ml
+|<nowiki>-</nowiki>
-Acid and alkaline phosphtase
+|<nowiki>-</nowiki>
-*Useful in detecting metasstasis
+|<nowiki>-</nowiki>
-Serurm creatinine and LFT
+|<nowiki>-</nowiki>
-*Useful in detecting metasstasis
+|<nowiki>-</nowiki>
-Urine analysis
+|Serum chemistry study
-*May detect hematuria or infection
-|Ultrasound
+*High levels of [[prostaglandin]] metabolites have been linked with [[osteoid osteoma]]s
-*Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity
+|Radiography
+*May demonstrate sclerosis around a radiolucent nidus
+CT
+*Demonstrates the margins of the nidus and calcifications present
 MRI
-*May be used to guide biopsy
-|PSA and DRE are gold standard for screening
+*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
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology
+![[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>
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Diease
+|Chronic
-! colspan="17" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical Manifestation
+|Weeks to years
-! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis
+|Severe, sharp
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Comments
+|Variable
-|-
+|<nowiki>-</nowiki>
-! 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
+|<nowiki>-</nowiki>
-! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
+|<nowiki>-</nowiki>
-|-
+|<nowiki>-</nowiki>
-! 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
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness
+|<nowiki>-</nowiki>
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever
+| -
-! 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
+*Typically no specific lab findings
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Syncopy
+*Elevated [[LDH]] and [[alkaline phosphatase]] may suggest pulmonary metastasis
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
+|
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Motor weakness
+Radiography
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Sensory deficit
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Pulse Deficit
+*May demonstrate an osteolytic or osteoblastic lesion
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Heart Murmur
+*Elevation of the periosteum may be noted, and is known as "Codman's triangle"
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel or bladder dysfunction
+*Tumor spread to periosteum is known as "sunburst" sign
-! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
+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
 |-
-! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Muscle-related
+![[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>
-![[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
+|Months to years
-|Dull aching
+|Severe, sharp
-|Shoulders, arms, hips, legs
+|Lower abdomen, hips, groin 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>
-|<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>
+|[[PSA]]
-|<nowiki>-</nowiki>
+*Detection is helpful in diagnosis, usually > 10 ng/ml
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+Acid and [[alkaline phosphatase]]
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+*Useful in detecting metastasis
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+Serurm creatinine and LFT
-|
-*Typically no specific lab findings
+*Useful in detecting metasstasis
-|
-MRI and ultrasound
+Urine analysis
-*May be utilized in non-resolution of muscle spasm to visualize the soft tissue
+*May detect [[hematuria]] or infection
+|Ultrasound
+*Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity
+MRI
+*May be used to guide biopsy
 |
-*Rest, bandaging and topical analgesics are often used to treat
+*PSA and DRE are gold standard for screening
 |-
-!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>
+! 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
-|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 analgesics 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
@@ Line 2,243: / Line 2,684: @@
 ! 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 2,259: / Line 2,700: @@
 ! align="center" style="background:#4479BA; color: #FFFFFF;" |Horner's syndrome
 |-
-! rowspan="9" align="center" style="background:#4479BA; color: #FFFFFF;" |Miscellaneous
+! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Muscle-related
-![[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>
+![[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
-|Variable
+|Shoulders, arms, hips, legs
-| +/-
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-| +/-
-|<nowiki>+/-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 2,279: / Line 2,720: @@
 |<nowiki>-</nowiki>
 |
-*Typically no specific lab findings, however, serology may be somewhat specific and demonstrate;
+*Typically no specific lab findings
-**Elevated IgM and/or IgG in coxsackievirus B titer
+|
-**Elevated IgM and/or IgG human herpesvirus 6 titer
+*Typically no routine imaging done, diagnosed clinically
-**Elevated IgM/IgG  in C pneumoniae titer
+|
-**Decrease in natural killer cell percentage or activity
+*Back brace maybe used with gentle exercise
-*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]]<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>
+![[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>
-|Chronic
+|Acute
-|Months to years
+|Days, weeks, months
-|Severe to mild aching
+|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
-**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 hyporpituitarism
-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]]<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>
-|Acute
-|3 - 7 days
-|Burning, dull aching or severe
-|Groin, hips, legs
-| -
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-| +/-
-| +/-
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 2,368: / Line 2,745: @@
 |<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
 |-
-![[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>
+!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>
-|Acute
+|Chronic
-|3 - 7 days
+|Years
-|Burning, dull aching or severe
+|Aching
-|Groin, hips, legs
+|Hips and legs
+|<nowiki>+/-</nowiki>
 | -
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-| +/-
+|<nowiki>-</nowiki>
-| +/-
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 2,390: / Line 2,772: @@
 |<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
 |-
-![[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>
+! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
-|Acute or chronic
+! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
-|Variable
+! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab findings
-|Severe, stabbing, electric-like
+! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
-|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>
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
-|Chronic
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration
-|Pregnancy term
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain
-|Dull aching
+! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation
-|Groin, hips, legs
+! 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="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>
@@ Line 2,442: / Line 2,829: @@
 |<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
-![[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>
+**Elevated IgM/IgG  in C pneumoniae titer
-|Acute or chronic
+**Decrease in [[natural killer cell]] percentage or activity
-|Variable
+*Labs used to exclude other pathologies include;
-|Severe, sharp
+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]]<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>
-|
-|
-|
-|-
-![[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>
-|Chronic
-|Years
-|Dull aching
-|Variable
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
@@ Line 2,486: / Line 2,896: @@
 |<nowiki>-</nowiki>
 |
-|
+*Typically no specific lab findings
-|
+*Lab testing is used to diagnose organic causes and include;
-|-
+**[[CBC]]
-![[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>
+**TFT
-|Acute or chronic
+**Vitamin B-12 detection
-|Variable
+**[[Rapid plasma reagin]]
-|Severe, sharp to dull aching
+**[[HIV]] testing
-|Variable
+**[[Electrolytes]], especially [[calcium]], [[phosphate]], and [[magnesium]] levels
-|<nowiki>+/-</nowiki>
+**[[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
+|-
+![[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>
+|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>
 |<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
-![[Ureteropelvic junction obstruction]]<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>
+***[[Gonorrhea]], [[chlamydia]], and [[PID]]
-|Acute
+**Beta - Human chorionic gonadotropin
-|Hours to days
+***Elevated in [[pregnancy]]
-|Dull aching
+**ESR
-|Groin, hips, legs
+**Elevated in subacute [[salpingitis]]
-| -
+**Urine analysis
-|<nowiki>+/-</nowiki>
+**To rule out [[urinary tract infection]]
-|<nowiki>+/-</nowiki>
+**Stool guaiac test
-|<nowiki>+/-</nowiki>
+***To rule out gastrointestinal bleeding
-|<nowiki>+/-</nowiki>
+|Ultrasound
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
+*May reveal [[endometriosis]] as complex mass with specks
-|<nowiki>-</nowiki>
+*[[Ectopic pregnancy]]
-|<nowiki>-</nowiki>
+*Ovarian cysts
-|<nowiki>-</nowiki>
+*[[Fibroid]]s
-|<nowiki>-</nowiki>
+*Intrauterine contraceptive device
-|<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
+Hysterosalpingography
-|
-|
+*May demonstrate [[endometrial polyp]]s
-|
+*[[Leiomyoma]]s
-|}
+*Congenital abnormalities of the uterus
-==References==
+IVP
-{{Reflist|2}}
+*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
+|
+|-
+![[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>
+|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%
+*[[Leukocytosis]] with predominance of [[neutrophils]]
+*[[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]]
+|-
+![[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>
+|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>
+|<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
+|
+|-
+![[Physical trauma|Trauma]]<ref name="pmid20489662">{{cite journal |vauthors=Inaba K, DuBose JJ, Barmparas G, Barbarino R, Reddy S, Talving P, Lam L, Demetriades D |title=Clinical examination is insufficient to rule out thoracolumbar spine injuries |journal=J Trauma |volume=70 |issue=1 |pages=174–9 |date=January 2011 |pmid=20489662 |doi=10.1097/TA.0b013e3181d3cc6e |url=}}</ref>
+|Acute or chronic
+|Variable
+|Severe, sharp to dull aching
+|Variable
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+| +/-
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+| +/-
+|<nowiki>+/-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>-</nowiki>
+|<nowiki>+/-</nowiki>
+|<nowiki>+/-</nowiki>
+|After establishment of first aid protocol, the following lab tests may be useful;
+Pregnancy test
+*In women of child-bearing age
+Blood typing, screening and cross matching
+*In case of [[blood transfusion]]
+Prothrombin time
+*To assess those taking [[warfarin]]
+Creatine kinase
+*To determine incidence of [[rhadomyolysis]]
+Blood sugar
+*To determine [[hypoglycemia]]
+Cardiac enzymes
+*To determine incidence of [[myocardial infarction]]
+Toxicology screen and alcohol level
+*To determine alcoholism and drug use
+Serum lactate
+*Elevated serum [[lactate]] may indicate a serious injury
+|To assess trauma, the following imaging may be used;
+*Portable radiography
+*Ultrasound
+*CT
+*Peritoneal tap or lavage
+*Echocardiography
+|
+|-
+![[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>
+|Acute
+|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}}
 [[Category:Pain]]
@@ Line 2,542: / 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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