Back pain physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Patients with back pain have variable presentation depending on the severity of pain and associated signs and symptoms.
Physical Examination
Physical examination of patients with back pain depends on the underlying etiology and severity.
Appearance of the Patient
Vital Signs
- Vital signs are usually normal.
- If fever is present then infectious cause should be investigated.
Skin
- Skin examination of patients with back pain is usually normal.
- Signs of trauma should be observed, including, contusions, abrasions, point tenderness.
HEENT
- HEENT examination of patients with [disease name] is usually normal.
OR
- Abnormalities of the head/hair may include ___
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- Hearing acuity may be reduced
- Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
- Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
- Exudate from the ear canal
- Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
- Inflamed nares / congested nares
- Purulent exudate from the nares
- Facial tenderness
- Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
- Neck examination of patients with [disease name] is usually normal.
OR
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
Lungs
- Pulmonary examination of patients with back pain is usually normal.
Heart
- Cardiovascular examination of patients with back pain is usually normal.
Abdomen
- Abdominal examination of patients with back pain is usually normal.
Back
- Restricted range of motion and muscular tenderness tenderness are observed in patients with lumbosacral muscle strains/sprains.[1]
- Pain on extension and rotation of hips may be present in patients with lumbar spondylosis along with pain radiating to hips.[2]
- Point tenderness can be seen in patients with vertebral compression fracture.
Genitourinary
- Genitourinary examination of patients with back pain is usually normal. However, if any abnormality is recognized further investigation must be done to rule-out a more serious condition.
Neuromuscular
- Paresthesia, sensory deficit, decreased muscular strength or diminished reflexes may be observed in patients with herniated disc.
- Motor deficit in legs and sensory loss is also seen in patients with spinal stenosis.
Extremities
- Extremities examination is usually normal or could show signs of trauma if that is the cause of back pain.
- Straight leg raise (SLR) should be done to investigate for lumbar disk herniation.[3]
- One leg hyperextension test looks for pars interarticularis defect as a cause of back pain.[4]
- Look for signs of IV drug abuse.
References
- ↑ Casser, Hans-Raimund; Seddigh, Susann; Rauschmann, Michael (2016). "Acute Lumbar Back Pain: Investigation, Differential Diagnosis, and Treatment". Deutsches Aerzteblatt Online. doi:10.3238/arztebl.2016.0223. ISSN 1866-0452.
- ↑ Middleton, Kimberley; Fish, David E. (2009). "Lumbar spondylosis: clinical presentation and treatment approaches". Current Reviews in Musculoskeletal Medicine. 2 (2): 94–104. doi:10.1007/s12178-009-9051-x. ISSN 1935-973X.
- ↑ Deyo RA, Rainville J, Kent DL (1992). "What can the history and physical examination tell us about low back pain?". JAMA. 268 (6): 760–5. PMID 1386391.
- ↑ Patel DR, Kinsella E (2017). "Evaluation and management of lower back pain in young athletes". Transl Pediatr. 6 (3): 225–235. doi:10.21037/tp.2017.06.01. PMC 5532202. PMID 28795014.