Lbp is thought to be a chronic issue in approximately 10% of the u. Differential diagnosis of a patient with low back and toe pain. While most causes of lbp among older adults are nonspecific and self. The etiological characterization of low back pain is a process that requires a propaedeutic. Startup back or buttock pain may indicate spinal instability. Preventive back exercises, techniques of manual medicine, and. The clinician should be aware of these risk factors when counselling and treating patients. The patient in this residents case problem was a 67yearold male referred to physical therapy with a 2week history of severe low back pain and muscle spasms. A 26yearold male sought physical therapy services via direct access secondary to a flareup of a chronic low back pain condition. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical. Jan 14, 2016 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Data examined included demographic features of patients, duration of back pain, muscles involved, primary diagnosis, treatment modality and response to treatment. The possibility of referred pain from other organ systems should also be considered.
Low back pain share this page pain in the lower back area that can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back. Pdf low back pain is a symptom affecting millions of adults annually. 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. Acute low back pain can be defined as six to 12 weeks of pain between the costal angles and gluteal folds that may radiate down one or both legs sciatica. Assessment of back pain differential diagnosis of symptoms. Low back pain is a symptom affecting millions of adults annually. 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. Nov, 2014 the issue of low back pain lbp is as common as it is perplexing. A 38yearold man with a history of chronic episodic low back pain lbp was referred to physical therapy by his physician. Low back pain is the commonest cause for years lived with disability. Abstractosteitis condensans ilii oci is a benign pathology causing chronic back and hip pain. Approximately two thirds of adults are affected by mechanical low back pain. Low back pain share this page pain in the lower back area that can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, or the skin covering the lumbar area.
Given this complexity, the diagnostic evaluation of patients with lbp can be very challenging and requires complex clinical decisionmaking. Diagnosis history the patient, a 38yearold male journalist, was referred by a physician with the diagnosis of chronic lbp. Low back pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. A thorough history and physical exam are imperative. Correlation between persistent neurological impairment and clinical outcome following microdiscectomy for treatment of lumbar disc herniation. Contact us if you experience any difficulty logging in. Jan 16, 2019 lower back pain is one of the most prevalent sports maladies, affecting athletes in nearly every sport. Most patients with back pain can be treated at the primary care setting, provided that the gp has the proper knowledge to elaborate the differential diagnosis of. Low back pain lbp is one of the most frequent patient complaints in primary care. In rosens emergency medicine concepts and clinical practice 8th ed. 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. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain causes of back pain key historical findings onset acute onset. Serious adverse reactions following immunisation with adult tickborne encephalitis tbe vaccines are rare, but when they occur, they most frequently involve the nervous system.
It is usually defined as pain, muscle tension, or stiffness localised below the costal margin and above the inferior gluteal folds, with or without leg pain sciatica. With spondylolysis or spondylolisthesis, the patient will usually complain of increased pain with hyperextension of the lower spine. 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. Differential diagnosis of spondylolysis in a patient with chronic low back pain jill theinnissenbaum, mpt, scs, atc1 william g. Persistent coccydynia the importance of a differential. Acute back pain has wide differential diagnoses, ranging from benign, selflimiting conditions to lifethreatening conditions. Low back pain lbp is a common reason for office appointments in the united states, accounting for 2% of all visits. The first step implies examining the presence of neuropathic low back pain. Jun 15, 2006 low back pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. Acute back pain clinical features and differential diagnosis.
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. Investigation, differential diagnosis, and treatment. 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. It is associated with disability, health care expenses, and a loss of wages and productivity. Differential diagnosis of low back pain article pdf available in seminars in pain medicine 23. Some occupations, such as heavy lifters, miners and truck drivers, have an increased prevalence of back pain due to repetitive mechanical strain to the back. The etiological characterization of low back pain is a process that requires a propaedeutic approach that includes the clinical history, physical and complementary exams.
Bertolottis syndrome is a frequent anomaly which can be related to lower back pain. Diagnosing the cause of a back injury is quite difficult and challenging because multiple structures in the lower back region can cause pain. Common lbp diagnoses include nonspecific lbp, radicular pain, lumbardisk herniation, spinal infection, and. When a patient presents with a problem that appears likely to be mechanical, it may well be the case, but you need also to consider inflammatory conditions, infectious problems, fractures, referred and functional pain. Access to society journal content varies across our titles. 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. Slipman cw, sterenfeld eb, chou lh, herzog r, vresilovic e. Learning point the differential diagnosis of back pain in children includes. The primary task when evaluating patients with low back pain is to identify those who have a serious cause of back pain that requires specific, and sometimes rapid, diagnosis. Owing to the scarcity of pathologic evidence, there exists much perplexity as to the origin of the pain accompanying disorders in the lower part of the back, and one wonders whether the old conceptions of the sacrolumbar and sacroiliac entities are any longer adequate. Even when back pain is associated with specific imaging findings such as degenerative disk disease, spondylolysis, spondylolisthesis, or osteoporosis, it may be impossible to determine whether the finding is the cause of the.
Low back pain lbp is a condition of localized pain to the lumbar spine with or without symptoms to the distal extremities whose aetiology is commonly unknown. Differential diagnosis of chronic low back pain university of. The authors present the case of a sacral chordoma in which the diagnosis was delayed as the patient was diagnosed and treated as coccydynia. The issue of low back pain lbp is as common as it is perplexing. A thorough history and physical exam will aid the provider in identifying the correct diagnoses.
Examples of nociceptive pain include pain after surgery, arthritis pain, mechanical low back pain, and pain associated with sports injuries. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical algorithm. 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. Differential diagnosis of a patient referred to physical. Patients with chronic low back pain are more likely to see a family physician 65. In the differential diagnosis of low back pain, the main point is that 97% of cases are mechanical figure 1. Differential diagnosis of spondylolysis in a patient with. Differential diagnosis of knee pain november 11, 2016. Most patients with back pain can be treated at the primary care setting, provided that the gp has the proper knowledge to elaborate the differential diagnosis of this. The treatment of acute, nonspecific low back pain focuses on pain relief and functional improvement. It is the fifth most common reason for all physician visits in the us. 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. The correct diagnosis was made in this patient but after significant delay. Information gathered from the history and administration of special tests.
Back pain is a common presentation to the emergency department. Most low back pain is caused by conditions that are troublesome but not progressive or lifethreatening. Explain the preliminary differential diagnoses and initial workup plan to the patient. Low back pain lbp is the most common musculoskeletal condition affecting the adult population, with a prevalence of up to 84% 1. This discussion will focus on an approach to the initial evaluation, including diagnostic tests, of a patient presenting with low back pain in the primary care setting. 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.
Lower back pain persists on a daily basis and increases with bending and twisting. Abdominal differential diagnosis in a patient referred to a. 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. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica.
The most important symptoms of nonspecific low back pain are pain and disability. The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. 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. The differential diagnosis of neurogenic and referred leg pain. Pdf differential diagnosis of low back pain researchgate. The patients chief presenting complaint was central, mid, and low lumbar pain.
Chronic lbp clbp is a chronic pain syndrome in the lower back region, lasting for at least 12 weeks 2. Descriptive epidemiology of lowback pain and its related medical care in the united states. 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. Many authors suggest defining chronic pain as pain. Diagnostic evaluation of low back pain with emphasis on imaging.
The information and recommendations appearing on this page are appropriate. Pdf on dec 1, 2002, hazel jenkins and others published classification of low back pain find, read and cite all the research you need on. Always be familiar with the childs medical history focused history of musculoskeletal pain. The annual incidence in the adult population is 10% to 15% with a point prevalence of approximately 30% in developed countries. Low back pain is the leading cause of long term disability worldwide. Meralgia paresthetica in differential diagnosis of low. Back pain that lasts 4 to 12 weeks is called subacute back pain. Low back pain is the leading cause of disability worldwide. 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. The patient history and physical examination were suggestive of musculoskeletal back pain and physical therapy treatment was initiated. Diagnosis concerns ascertained from the patients history included an insidious onset of unrelenting, deep, boring pain. Nov 01, 2010 therefore with bilateral spondylolysis or bilateral fractures the vertebral pedicle slips anteriorly.
Objective meralgia paresthetica is a syndrome of pain or dysesthesia or both in the anterolateral thigh, caused by entrapment of the lateral femoral cutaneous nerve at the anterior superior iliac spine. It should be considered as a differential diagnosis when confronting a patient with compatible radiographic findings and persistent back pain. The classification criteria are substantiated by several original research. Although the definitive cause is uncertain, mechanical stress is a significant factor in the. 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.
This case highlights the physical therapy examination, intervention, and outcomes of a 32yearold, 26 weeks gestation, complaining of low back pain. Assessment of back pain differential diagnosis of symptoms bmj. Low back pain has a lifetime prevalence of approximately 80%. Be sure to keep in mind the red flags for back pain. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Despite the availability of modern diagnostic tools, the cause of the pain generator. Persistent, severe coccydynia following minor trauma is common11 but the symptom can also be caused by significant underlying disease. Diagnosis and management of acute low back pain american. Instructional course lecture differentiating hip pathology. 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 caused by fragility fractures in osteoporosis patients has been found to have the most signi. Initial imaging with mri, which is the preferred study, or ct is only rec. The aim of this report is to emphasize that meralgia paresthetica can be confused with low back pain patient a 21yearold man was admitted to hospital because of low back and thigh pain. Low back pain lbp is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%.
It is concluded that low back pain, a disease of the. Diagnosis and treatment of acute low back pain american. Back pain is the primary cause of disability in people of age. Back pain is the most common cause of shortterm disability in adults younger than 45 years and the. There was good tone and strength, with normal deep tendon reflexes and normal sensation in the lower extremities. Back pain is the primary cause of disability in people low back pain. Common lbp diagnoses include nonspecific lbp, radicular pain, lumbardisk herniation, spinal infection, and ankylosing spondylitis.
Patient strained lower back unloading a truck, which required lifting heavy boxes, twisting and placing boxes on flats three years ago. Osteitis condensans ilii in differential diagnosis of. Signs and symptoms the list of differential diagnoses for lower extremity pain is extensive and broad. Table 1 presents the differential diagnosis of acute low back pain. However, between 38% and 52% of asymptomatic individuals demonstrated significant lumbar disc bulging on mri. The most important symptoms of nonspecific low back pain are pain. Low back pain and pelvic floor disorders physiopedia. 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. These structures may be causing direct or referred pain patterns. Differential diagnosis and physical therapy management of. Buy this article and get unlimited access and a printable pdf.