Back pain differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 68: | Line 68: | ||
!Horner's syndrome | !Horner's syndrome | ||
|- | |- | ||
! rowspan="7" |Vascular | |||
!Aortic dissection | |||
| | | | ||
| | | | ||
| Line 87: | Line 87: | ||
| | | | ||
|- | |- | ||
!Aortic aneurysm | |||
- Abdominal aneurysm | - Abdominal aneurysm | ||
| Line 108: | Line 108: | ||
| | | | ||
|- | |- | ||
!Adrenal haemorrhgage | |||
| | | | ||
| | | | ||
| Line 126: | Line 126: | ||
| | | | ||
|- | |- | ||
!Chronic stable angina | |||
| | | | ||
| | | | ||
| Line 144: | Line 144: | ||
| | | | ||
|- | |- | ||
!Pulmonary embolism | |||
| | | | ||
| | | | ||
| Line 162: | Line 162: | ||
| | | | ||
|- | |- | ||
!Traumatic aortic rupture | |||
| | | | ||
| | | | ||
| Line 180: | Line 180: | ||
| | | | ||
|- | |- | ||
!Retroperitoneal hematoma | |||
| | | | ||
| | | | ||
| Line 198: | Line 198: | ||
| | | | ||
|- | |- | ||
! rowspan="6" |Neurological | |||
!Arachnoiditis | |||
| | | | ||
| | | | ||
| Line 217: | Line 217: | ||
| | | | ||
|- | |- | ||
!Spinal cord compression | |||
- Thoracic spine | - Thoracic spine | ||
| Line 239: | Line 239: | ||
| | | | ||
|- | |- | ||
!Cauda equina syndrome | |||
| | | | ||
| | | | ||
| Line 257: | Line 257: | ||
| | | | ||
|- | |- | ||
!Radiculopathy | |||
| | | | ||
| | | | ||
| Line 275: | Line 275: | ||
| | | | ||
|- | |- | ||
!Epidural abscess | |||
| | | | ||
| | | | ||
| Line 293: | Line 293: | ||
| | | | ||
|- | |- | ||
!Sciatica | |||
| | | | ||
| | | | ||
| Line 311: | Line 311: | ||
| | | | ||
|- | |- | ||
! rowspan="18" |Bone | |||
!Discitis/discopathy | |||
| | | | ||
| | | | ||
| Line 330: | Line 330: | ||
| | | | ||
|- | |- | ||
!Vertebral osteomyelitis | |||
| | | | ||
| | | | ||
| Line 348: | Line 348: | ||
| | | | ||
|- | |- | ||
!Septic sacroilitis | |||
| | | | ||
| | | | ||
| Line 366: | Line 366: | ||
| | | | ||
|- | |- | ||
!Vertebral compression fracture | |||
| | | | ||
| | | | ||
| Line 384: | Line 384: | ||
| | | | ||
|- | |- | ||
!Spinal stenosis | |||
| | | | ||
| | | | ||
| Line 402: | Line 402: | ||
| | | | ||
|- | |- | ||
!Osteoarthritis | |||
| | | | ||
| | | | ||
| Line 420: | Line 420: | ||
| | | | ||
|- | |- | ||
!Ankylosing spondylitis | |||
| | | | ||
| | | | ||
| Line 438: | Line 438: | ||
| | | | ||
|- | |- | ||
!Chronic recurrent focal osteomyelitis | |||
| | | | ||
| | | | ||
| Line 456: | Line 456: | ||
| | | | ||
|- | |- | ||
!Scoliosis | |||
| | | | ||
| | | | ||
| Line 474: | Line 474: | ||
| | | | ||
|- | |- | ||
!Hyperkyphosis | |||
| | | | ||
| | | | ||
| Line 492: | Line 492: | ||
| | | | ||
|- | |- | ||
!Spondylosis | |||
-Spondylolisthesis | -Spondylolisthesis | ||
| | | | ||
| Line 511: | Line 511: | ||
| | | | ||
|- | |- | ||
!Cervical fracture | |||
| | | | ||
| | | | ||
| Line 529: | Line 529: | ||
| | | | ||
|- | |- | ||
!Scheuermann (juvenile) kyphosis | |||
| | | | ||
| | | | ||
| Line 547: | Line 547: | ||
| | | | ||
|- | |- | ||
!Disc herniation | |||
| | | | ||
| | | | ||
| Line 565: | Line 565: | ||
| | | | ||
|- | |- | ||
!Sacroiliac joint dysfunction | |||
| | | | ||
| | | | ||
| Line 583: | Line 583: | ||
| | | | ||
|- | |- | ||
!Bertolotti's syndrome (Lumbosacral transitional vertebrae) | |||
| | | | ||
| | | | ||
| Line 601: | Line 601: | ||
| | | | ||
|- | |- | ||
!Degenerative disc disease | |||
| | | | ||
| | | | ||
| Line 619: | Line 619: | ||
| | | | ||
|- | |- | ||
!Osteoarthritis | |||
| | | | ||
| | | | ||
| Line 637: | Line 637: | ||
| | | | ||
|- | |- | ||
! rowspan="11" |Non-spinal infections | |||
!Pyomyositis | |||
| | | | ||
| | | | ||
| Line 656: | Line 656: | ||
| | | | ||
|- | |- | ||
!Pyelonephritis | |||
| | | | ||
| | | | ||
| Line 674: | Line 674: | ||
| | | | ||
|- | |- | ||
!Nephrolithiasis | |||
| | | | ||
| | | | ||
| Line 692: | Line 692: | ||
| | | | ||
|- | |- | ||
!Pelvic inflammatory disease | |||
| | | | ||
| | | | ||
| Line 710: | Line 710: | ||
| | | | ||
|- | |- | ||
!Pneumonia | |||
| | | | ||
| | | | ||
| Line 728: | Line 728: | ||
| | | | ||
|- | |- | ||
!Endocarditis | |||
| | | | ||
| | | | ||
| Line 746: | Line 746: | ||
| | | | ||
|- | |- | ||
!Myalgia | |||
| | | | ||
| | | | ||
| Line 764: | Line 764: | ||
| | | | ||
|- | |- | ||
!Cystitis | |||
| | | | ||
| | | | ||
| Line 782: | Line 782: | ||
| | | | ||
|- | |- | ||
!Cholelithiasis | |||
| | | | ||
| | | | ||
| Line 800: | Line 800: | ||
| | | | ||
|- | |- | ||
!Appendicitis | |||
| | | | ||
| | | | ||
| Line 818: | Line 818: | ||
| | | | ||
|- | |- | ||
!Inflammatory arthritis | |||
| | | | ||
| | | | ||
| Line 836: | Line 836: | ||
| | | | ||
|- | |- | ||
! rowspan="9" |Tumors | |||
!Osteoid osteoma | |||
| | | | ||
| | | | ||
| Line 855: | Line 855: | ||
| | | | ||
|- | |- | ||
!Osteoblastoma | |||
| | | | ||
| | | | ||
| Line 873: | Line 873: | ||
| | | | ||
|- | |- | ||
!Ewing sarcoma | |||
| | | | ||
| | | | ||
| Line 891: | Line 891: | ||
| | | | ||
|- | |- | ||
!Osteosarcoma | |||
| | | | ||
| | | | ||
| Line 909: | Line 909: | ||
| | | | ||
|- | |- | ||
!Lymphoma | |||
| | | | ||
| | | | ||
| Line 927: | Line 927: | ||
| | | | ||
|- | |- | ||
!Prostate cancer | |||
| | | | ||
| | | | ||
| Line 945: | Line 945: | ||
| | | | ||
|- | |- | ||
!Neurofibroma | |||
| | | | ||
| | | | ||
| Line 963: | Line 963: | ||
| | | | ||
|- | |- | ||
!Leukemia | |||
| | | | ||
| | | | ||
| Line 981: | Line 981: | ||
| | | | ||
|- | |- | ||
!Langerhan cell histocytosis (eosinophilic granulomas) | |||
| | | | ||
| | | | ||
| Line 999: | Line 999: | ||
| | | | ||
|- | |- | ||
! rowspan="3" |Muscle-related | |||
!Pyriformis syndrome | |||
| | | | ||
| | | | ||
| Line 1,018: | Line 1,018: | ||
| | | | ||
|- | |- | ||
!Muscle spasm | |||
| | | | ||
| | | | ||
| Line 1,036: | Line 1,036: | ||
| | | | ||
|- | |- | ||
!Abnormal posture | |||
| | | | ||
| | | | ||
| Line 1,054: | Line 1,054: | ||
| | | | ||
|- | |- | ||
! rowspan="9" |Miscellaneous | |||
!Trauma | |||
| | | | ||
| | | | ||
| Line 1,073: | Line 1,073: | ||
| | | | ||
|- | |- | ||
!Pregnancy | |||
| | | | ||
| | | | ||
| Line 1,091: | Line 1,091: | ||
| | | | ||
|- | |- | ||
!Premenstrual syndrome | |||
| | | | ||
| | | | ||
| Line 1,109: | Line 1,109: | ||
| | | | ||
|- | |- | ||
!Herpes zoster | |||
| | | | ||
| | | | ||
| Line 1,127: | Line 1,127: | ||
| | | | ||
|- | |- | ||
!Sickle cell anemia | |||
| | | | ||
| | | | ||
| Line 1,145: | Line 1,145: | ||
| | | | ||
|- | |- | ||
!Syringomyelia | |||
| | | | ||
| | | | ||
| Line 1,163: | Line 1,163: | ||
| | | | ||
|- | |- | ||
!Ureteropelvic junction obstruction | |||
| | | | ||
| | | | ||
| Line 1,181: | Line 1,181: | ||
| | | | ||
|- | |- | ||
!Chronic pain syndrome | |||
| | | | ||
| | | | ||
| Line 1,199: | Line 1,199: | ||
| | | | ||
|- | |- | ||
!Psychologic distress | |||
| | | | ||
| | | | ||
Revision as of 14:37, 22 March 2018
|
Back pain Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Lecture |
|
Case Studies |
|
Back pain differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Back pain differential diagnosis |
|
Risk calculators and risk factors for Back pain differential diagnosis |
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 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.
Differential Diagnosis
Life Threatening Causes
Life threatening diseases to exclude immediately include:[1][2][3][4][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17]
- 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
- Abnormal posturing
- Degenerative disc disease
- Depression
- Discopathy
- Osteoarthritis
- Pregnancy
- Premenstrual syndrome
- Sciatica
- Spinal disc herniation
- Spinal stenosis
- Trauma
Differential Diagnosis of Back Pain
| Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Signs | Lab findings | Imaging | ||||||||||||||
| Onset | Duration | Quality of pain | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Weight loss | Motor weakness | Sensory deficit | Bowel or bladder dysfunction | Horner's syndrome | |||||
| Vascular | Aortic dissection | ||||||||||||||||
| Aortic aneurysm
- Abdominal aneurysm - Thoracic aneurysm |
|||||||||||||||||
| Adrenal haemorrhgage | |||||||||||||||||
| Chronic stable angina | |||||||||||||||||
| Pulmonary embolism | |||||||||||||||||
| Traumatic aortic rupture | |||||||||||||||||
| Retroperitoneal hematoma | |||||||||||||||||
| Neurological | Arachnoiditis | ||||||||||||||||
| Spinal cord compression
- Thoracic spine - Lumbar spine |
|||||||||||||||||
| Cauda equina syndrome | |||||||||||||||||
| Radiculopathy | |||||||||||||||||
| Epidural abscess | |||||||||||||||||
| Sciatica | |||||||||||||||||
| Bone | Discitis/discopathy | ||||||||||||||||
| Vertebral osteomyelitis | |||||||||||||||||
| Septic sacroilitis | |||||||||||||||||
| Vertebral compression fracture | |||||||||||||||||
| Spinal stenosis | |||||||||||||||||
| Osteoarthritis | |||||||||||||||||
| Ankylosing spondylitis | |||||||||||||||||
| Chronic recurrent focal osteomyelitis | |||||||||||||||||
| Scoliosis | |||||||||||||||||
| Hyperkyphosis | |||||||||||||||||
| Spondylosis
-Spondylolisthesis |
|||||||||||||||||
| Cervical fracture | |||||||||||||||||
| Scheuermann (juvenile) kyphosis | |||||||||||||||||
| Disc herniation | |||||||||||||||||
| Sacroiliac joint dysfunction | |||||||||||||||||
| Bertolotti's syndrome (Lumbosacral transitional vertebrae) | |||||||||||||||||
| Degenerative disc disease | |||||||||||||||||
| Osteoarthritis | |||||||||||||||||
| Non-spinal infections | Pyomyositis | ||||||||||||||||
| Pyelonephritis | |||||||||||||||||
| Nephrolithiasis | |||||||||||||||||
| Pelvic inflammatory disease | |||||||||||||||||
| Pneumonia | |||||||||||||||||
| Endocarditis | |||||||||||||||||
| Myalgia | |||||||||||||||||
| Cystitis | |||||||||||||||||
| Cholelithiasis | |||||||||||||||||
| Appendicitis | |||||||||||||||||
| Inflammatory arthritis | |||||||||||||||||
| Tumors | Osteoid osteoma | ||||||||||||||||
| Osteoblastoma | |||||||||||||||||
| Ewing sarcoma | |||||||||||||||||
| Osteosarcoma | |||||||||||||||||
| Lymphoma | |||||||||||||||||
| Prostate cancer | |||||||||||||||||
| Neurofibroma | |||||||||||||||||
| Leukemia | |||||||||||||||||
| Langerhan cell histocytosis (eosinophilic granulomas) | |||||||||||||||||
| Muscle-related | Pyriformis syndrome | ||||||||||||||||
| Muscle spasm | |||||||||||||||||
| Abnormal posture | |||||||||||||||||
| Miscellaneous | Trauma | ||||||||||||||||
| Pregnancy | |||||||||||||||||
| Premenstrual syndrome | |||||||||||||||||
| Herpes zoster | |||||||||||||||||
| Sickle cell anemia | |||||||||||||||||
| Syringomyelia | |||||||||||||||||
| Ureteropelvic junction obstruction | |||||||||||||||||
| Chronic pain syndrome | |||||||||||||||||
| Psychologic distress | |||||||||||||||||
References
- ↑ Chou R, Qaseem A, Owens DK, Shekelle P (February 2011). "Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians". Ann. Intern. Med. 154 (3): 181–9. doi:10.7326/0003-4819-154-3-201102010-00008. PMID 21282698.
- ↑ 2.0 2.1 Schiff D, O'Neill BP, Suman VJ (August 1997). "Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach". Neurology. 49 (2): 452–6. PMID 9270576.
- ↑ 3.0 3.1 Deyo RA, Diehl AK (1988). "Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies". J Gen Intern Med. 3 (3): 230–8. PMID 2967893.
- ↑ Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS (April 2014). "Assessment of cauda equina syndrome progression pattern to improve diagnosis". Spine. 39 (7): 596–602. doi:10.1097/BRS.0000000000000079. PMID 24150427.
- ↑ Jarvik JG, Deyo RA (October 2002). "Diagnostic evaluation of low back pain with emphasis on imaging". Ann. Intern. Med. 137 (7): 586–97. PMID 12353946.
- ↑ Underwood MR, Dawes P (November 1995). "Inflammatory back pain in primary care". Br. J. Rheumatol. 34 (11): 1074–7. PMID 8542211.
- ↑ "Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research". Clin Pract Guidel Quick Ref Guide Clin (14): iii–iv, 1–25. December 1994. PMID 7987418.
- ↑ Ropper AH, Zafonte RD (March 2015). "Sciatica". N. Engl. J. Med. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.
- ↑ Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC (April 2015). "Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial". Ann. Intern. Med. 162 (7): 465–73. doi:10.7326/M14-1420. PMID 25844995.
- ↑ Papadopoulos EC, Khan SN (January 2004). "Piriformis syndrome and low back pain: a new classification and review of the literature". Orthop. Clin. North Am. 35 (1): 65–71. doi:10.1016/S0030-5898(03)00105-6. PMID 15062719.
- ↑ Hopayian K, Song F, Riera R, Sambandan S (December 2010). "The clinical features of the piriformis syndrome: a systematic review". Eur Spine J. 19 (12): 2095–109. doi:10.1007/s00586-010-1504-9. PMC 2997212. PMID 20596735.
- ↑ Potter NA, Rothstein JM (November 1985). "Intertester reliability for selected clinical tests of the sacroiliac joint". Phys Ther. 65 (11): 1671–5. PMID 2932746.
- ↑ Russel AS, Maksymowych W, LeClercq S (December 1981). "Clinical examination of the sacroiliac joints: a prospective study". Arthritis Rheum. 24 (12): 1575–7. PMID 7326071.
- ↑ Levangie PK (November 1999). "Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain". Phys Ther. 79 (11): 1043–57. PMID 10534797.
- ↑ Riddle DL, Freburger JK (August 2002). "Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study". Phys Ther. 82 (8): 772–81. PMID 12147007.
- ↑ Irwin RW, Watson T, Minick RP, Ambrosius WT (January 2007). "Age, body mass index, and gender differences in sacroiliac joint pathology". Am J Phys Med Rehabil. 86 (1): 37–44. PMID 17304687.
- ↑ Jancuska JM, Spivak JM, Bendo JA (2015). "A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome". Int J Spine Surg. 9: 42. doi:10.14444/2042. PMC 4603258. PMID 26484005.