Always be familiar with the childs medical history focused history of musculoskeletal pain timing of. Different than sleepnight pain this will hurt rest sitting with hands in lap usually rapidsudden onset 1010 pain out of clear blue sky may start soon after an event or recent incr. A history of startup groin pain ie, pain that usually improves after 5 to 10 steps and then gradually returns may indicate a loose total hip arthroplasty tha component. Low back pain is the commonest cause for years lived with disability. It also includes lower extremity pain that results from a low back disorder sciaticaradiating low back pain, whether there is trunk pain or not. It is associated with disability, health care expenses, and a loss of wages and productivity. The etiological characterization of low back pain is a process that requires a propaedeutic approach that includes the clinical history, physical and complementary exams.
An episode of low back pain is called acute if it has arisen for the first time in a patients life, or after a painfree interval of at least six months, and lasts no longer. There are published guidelines for the diagnosis and treatment of low back pain. Differential diagnosis of low back pain ppt xpowerpoint. Figure 71 reorganizes the differential diagnosis using pivotalpoints and outlines the diagnostic approach to low back pain. Low back pain that has been present for longer than three months is considered chronic, although there is still no consensus about the definition of clbp. Low back pain lumbar back pain is defined as pain in the back from the level of the lowest rib down to the gluteal fold, with or without radiation into the legs. Learning point the differential diagnosis of back pain in children includes. There was good tone and strength, with normal deep tendon reflexes and normal sensation in the lower extremities. Differential diagnosis of a patient referred to physical. The classification criteria are substantiated by several original research. In up to 85% of individuals, no specific cause can be isolated. Low back pain lbp is the fifth most common reason for physician visits, which affects nearly 6080% of people throughout their lifetime.
In rosens emergency medicine concepts and clinical practice 8th ed. Low back pain is the leading cause of long term disability worldwide. This subdivision is based on the duration of the back pain. Despite the availability of modern diagnostic tools, the cause of the pain generator is often unidentifiable. Low back pain lbp is posterior trunk pain between the ribcage and the gluteal folds. The vast majority of patients seen in primary care 85 percent will have nonspecific low back pain, meaning that the patient has back pain in the absence of a specific underlying condition that can be reliably identified 35. The discussion in this article is extensive but not allinclusive, and the clinician should consult other sources for more detailed description of the less common differential diagnoses. Lumbar 5th vertebra, lumbosacral transition, sacralization view fulltext. Acute low back pain acute low back pain is a common presenting illness in the primary care setting family physicians generally see at least one presentation a week. Jan 24, 2017 mechanical low back pain is one of the most common patient complaints expressed to emergency physicians in the united states accounting for more than 6 million cases annually. Nov 01, 2010 therefore with bilateral spondylolysis or bilateral fractures the vertebral pedicle slips anteriorly. Low back pain and differential diagnosis 2019 back pain help. Thus it will provide a comprehensive approach to differential diagnosis and management of low back pain.
Feb 01, 2014 compliant diagnosis differential diagnosis referred pain 1 42 yrs male, alcoholic has abdominal pain radiated to the back. Nonspecific back pain most people more than 85 percent have what doctors call nonspecific low back pain, which means that the pain is not clearly caused by a specific disease, abnormality, or serious injury of the spine. Differential diagnosis of low back pain n mechanical low back or leg pain 97% n lumbar strain, sprain 70% n degenerative processes of disks and facets, usually agerelated 10% n herniated disk 4% n spinal stenosis 3% n osteoporotic compression fracture 4% n spondylolisthesis 2% n traumatic fracture low back pain has a lifetime prevalence of approximately 80%. Apr 01, 2016 low back pain lumbar back pain is defined as pain in the back from the level of the lowest rib down to the gluteal fold, with or without radiation into the legs 5. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical algorithm.
People sometimes refer to throwing out their back, meaning they had suddenonset pain following physical activity. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of back pain key historical findings onset acute onset. Among asymptomatic individuals, 20% to 30% have evidence of a herniated disk on computed tomography ct or mri. Signs and symptoms the list of differential diagnoses for lower extremity pain is extensive and broad. The differential diagnosis of neurogenic and referred leg pain. You are annoyed when your back is examined because it is painful. Because of the increased pain with hyperextension, the physician thought that this could be a spondylolysis but the radiologic evaluation of lower spine radiographs were negative. Low back pain lbp is the most common musculoskeletal condition affecting the adult population, with a prevalence of up to 84% 1. Differential diagnosis of low back pain sciencedirect. In every patient with back pain, it is essential to systematically ask about and look for the clinical clues and pivotal points associated with serious causes of back pain. Low back pain is usually categorized in 3 subtypes. Low back pain online medical reference from definition and diagnosis through risk factors and. It is estimated that up to 84 percent of adults have low back pain at some time in their lives 1,2. Suspicion of such back pain causes would warrant the physical therapist referring the patient to a physician.
A case study department physical therapy degree doctor of physical therapy in presenting this scholarly project in partial fulfilhnent of the requirements for a graduate degree from the university of north dakota, i agree that the department of physical therapy shall make it freely available for inspection. Instructional course lecture differentiating hip pathology. Most commonly, diagnoses of acute painful spinal conditions are nonspecific, such as neck or back strain, although injuries may affect any of several pain sensitive structures, which include the disk, facet joints, spinal musculature, and ligamentous support. Low back pain, without symp toms or signs of serious. Although its not lifethreatening it can cause serious problems. Pain, stiffness, andor soreness of the lumbosacral. The icd diagnosis of low back pain low back strainlumbago and the associated icf diagnosis of acute or subacute low back pain with related cognitive or affective tendencies are made with a reasonable level of certainty when the patient presents with the following clinical findings 112, 124, 6, 183, 318. Statement of intent these guidelines are not intended to be construed as or to. Patient strained lower back unloading a truck, which required lifting heavy boxes, twisting and placing boxes on flats three years ago. A 26yearold male sought physical therapy services via direct access secondary to a flareup of a chronic low back pain condition. Diagnosis and treatment of acute low back pain aafp.
Lower back pain persists on a daily basis and increases with bending and twisting. Back pain is the primary cause of disability in people low back pain lbp is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Here we discuss about radicular pain, facet joint pain, sacroiliac pain, pain related to lumbar stenosis, discogenic pain. Chronic lbp clbp is a chronic pain syndrome in the lower back region, lasting for at least 12 weeks 2.
Startup back or buttock pain may indicate spinal instability. The treatment of acute, subacute, and chronic low back pain are discussed separately. Low back pain lbp is a common reason for office appointments in the united states, accounting for 2% of all visits. Medications do not relieve the constant dull ache or the intermittent sharp. Low back pain has a lifetime prevalence of approximately 80%. In every patient with back pain, it is essential to systematically ask about and look for the clinical clues and pivotal points associated with serious causes of back pain table 71. These structures may be causing direct or referred pain patterns. It is concluded that low back pain, a disease of the. The most important issue for emergency physicians is to be able to. The annual incidence in the adult population is 10% to 15% with a point prevalence of approximately 30% in developed countries. In patients with positive findings, the initial patientspecific differential is quickly limited. It is the fifth most common reason for all physician visits in the us.
A thorough history and physical exam will aid the provider in identifying the correct diagnoses. Feb 15, 2012 low quality evidence shows that in the first five days of acute low back pain, the use of heat treatments may be more effective for reducing pain and disability than nonheat wraps, nsaids, or. Lower back pain is now a days common in males, especially in 50 or more than 50 years old males. Displaying differential diagnosis of low back pain powerpoint presentations advanced imaging for low back pain 869473 ppt presentation summary. Initial imaging with mri, which is the preferred study, or ct is only rec. Evaluation of back pain differential diagnosis of symptoms bmj. Low back pain academy of orthopaedic physical therapy. Because of the weak associations among symptoms, physical findings, imaging results, and electromyograms, a majority of patients with low back pain. Back pain is a common presentation to the emergency department. Diagnosis is made by eliminating specific lower back pain causes of neurological compromise, neoplasia, inflammatory arthritis, fracture, or referred pain from other locations or organ systems. Nov 27, 2018 low back pain online medical reference from definition and diagnosis through risk factors and. See table 1 for the differential diagnosis for low back pain.
The issue of low back pain lbp is as common as it is perplexing. The differential diagnosis of low back pain wiley online library. Differential diagnosis of low back pain article pdf available in seminars in pain medicine 23. When the examinee enters the room, sit on the edge of the examination chair and try to.
Any innervated structure in the lumbar spine can cause symptoms of lbp. Sciatica is radiating, lower extremity pain and may not be associated with back pain. Musculoskeletal lower back pain differentials bmj best. Diagnosis and treatment of acute low back pain american. The recommendation on application of heat for shortterm relief of acute low back pain is based on expert opinion in several us clinical practice guidelines such as diagnosis and treatment of low back pain. Differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. The first step implies examining the presence of neuropathic low back pain. Lower extremity pain clinical guidelines for workup.
Lbp is thought to be a chronic issue in approximately 10% of the u. The etiological characterization of low back pain is a process that requires a propaedeutic approach that includes the clinical history. Some of the numerous causes of back pain are listed in table 4. An episode of low back pain is called acute if it has arisen for the first time in a patients life, or after a pain free interval of at least six months, and lasts no longer than. Assessment of back pain differential diagnosis of symptoms. An accurate diagnosis is essential for both acute and chronic low back pain conditions.
Specific causes of lbp are uncommon, and in approximately 90% of patients a specific generator cannot. Differential diagnosis of low back pain n mechanical low back or leg pain 97% n lumbar strain, sprain 70% n degenerative processes of disks and facets, usually agerelated 10% n herniated disk 4% n spinal stenosis 3% n osteoporotic compression fracture 4% n spondylolisthesis 2% n traumatic fracture low back pain in the primary care setting. Differential diagnosis of spondylolysis in a patient with chronic low back pain jill theinnissenbaum, mpt, scs, atc1 william g. The etiology of low back pain may be difficult to determine at times because of the number of diverse anatomic structures located in or near the low back region. Pdf differential diagnosis of low back pain researchgate. However, between 38% and 52% of asymptomatic individuals demonstrated significant lumbar disc bulging on mri. With spondylolysis or spondylolisthesis, the patient will usually complain of increased pain with hyperextension of the lower spine. Pearl major serious causes of back pain crafti cauda equina renal aorta aneurysm or dissection fracture infection workup labs usually low yield ua low threshold especially in female patients uti cbcchem 10 type and cross for 8 unitsemergency release blood if suspecting aaa esrcrp elevated in epidural abscess imaging bedside ultrasound. The most common form of low back pain is the one that is called nonspecific low back pain and is defined as low back pain not attributed to recognizable, known specific pathology. Low back pain caused by fragility fractures in osteoporosis patients has been found to have the most signi. Explain the preliminary differential diagnoses and initial workup plan to the patient.
Identify appropriate investigations and referrals for an individual complaining of lower back pain. Approximately two thirds of adults are affected by mechanical low back pain at some point in their lives, making it the second most common complaint in ambulatory medic. Nonspecific low back pain is common and usually selflimited. Table 1 presents the differential diagnosis of acute low back pain. Be able to outline a plan for managing both acute and chronic lower back pain. The discussion in this article is extensive but not all. According to jarvik and deyo,23 in approximately 7% to 8% of patients with lbp, the cause is due to nonmechanical spinal conditions or visceral disease. Imaging has limited utility because most patients with chronic low back pain have nonspecific findings on imaging studies,7 and asymptomatic patients often have abnormal 6findings. Terminology used in spine disc pathology and back pain differential diagnosis of low back pain risk factors for osteoporosis solitary nerve root lesions of the lumbosacral spine neurogenic vs vascular claudication manifestations of oa nonorganic low back pain signs waddell acp best practice advice lower back pain cancer tests for back pain.
Nov, 2014 the issue of low back pain lbp is as common as it is perplexing. When caring for a patient and developing a back pain differential diagnosis, remember to consider age, the history, physical exam findings, laboratory results, and imaging if needed. Be sure to keep in mind the red flags for back pain. May 25, 2018 differential diagnosis for abdominal pain based on history and physical examination in spite of the fact that area of stomach pain or abdominal pain directs the underlying assessment, related signs and indications are prescient of certain reasons for pain in the abdomen and can limit the differential diagnosis. Back pain is the most common cause of shortterm disability in adults younger than 45 years and the. Differential diagnosis of spondylolysis in a patient with.