Approach to Acute Back Pain

Approach to Acute Back Pain 2018-01-30T16:36:57+08:00

Differential diagnosis

  • Neurological
    • Spinal cord compression
    • Spinal stenosis
    • Epidural haematoma
    • Spinal tumour
    • Guillain-Barre syndrome
  • Infective
    • Discitis
    • Epidural abscess
    • Pyelonephritis
    • Acute pancreatitis
  • Bone
    • Bony metastases
    • Osteoporotic fracture
      • Cushing’s syndrome
      • Menopause
      • Rheumatoid arthritis
      • Hypogonadotropic hypogonadism (e.g. secondary to pan-hypopituitarism)
      • Coeliac disease
      • Inflammatory bowel disease
      • Hyperparathyroidism
      • Renal bone disease
      • Hyperthyroidism
    • Traumatic fracture
    • Multiple myeloma
  • Vascular
    • Aortic dissection
    • Spinal artery dissection
    • Ruptured abdominal aortic aneurysm
  • Autoimmune
    • Ankylosing spondylitis
    • Psoriatic arthritis
  • Mechanical back pain

History

  • SOCRATES
  • Any weakness?
  • Any numbness?
  • Any difficulty passing urine?
  • Any difficulty with passing motion?
  • Does the pain get better when you sit?
  • Does it get worse when you walk?
  • Any loss of weight / loss of appetite?
  • Do you feel more tired than usual?
  • Do you feel excessively thirsty? Passing a lot of urine?
  • Any change in bowel habit / PR bleed?
  • Any smoking history?
  • Any breast lumps?
  • Any pain on passing urine?
  • Any blood in urine?
  • Any difficulty in initiating urination? Terminal dribbling?
  • Any fever?
  • Any night sweats?
  • Any recent admission to hospital?
  • Any previous operations?
  • Any previous fractures?
  • From standing height?
  • Any trauma?
  • Any early morning stiffness?
  • Does back pain get better with exertion?
  • Any rashes?
  • Have you ever had episodes of red, painful eyes?
  • Any abdominal pain?
  • Do you lift heavy loads?
  • What is your job?

Examination

  • Stand up and look at back
  • Point tenderness along spine
  • Schoeber’s test
  • Range of movement
    • Flexion / extension
    • Rotation
  • Gait
  • Abdo:
    • Renal punch
    • AAA
  • Straight leg raise
  • Palpable bladder
  • Power in bilateral lower limbs
  • Plantars
  • Psoriatic rash
  • Psoriatic nail changes
  • Ankylosing spondylitis:
    • Heart: aortic regurgitation
    • Eyes: anterior uveitis
    • Lungs: upper lobe fibrosis
    • Achilles tendinitis
    • Atlanto-axial subluxation
  • Offer DRE

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This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.