differential diagnosis
TRANSCRIPT
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BACK PAIN... What else could it be?
Martin Melbye PT Dip MDT
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Possible diagnoses?
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Visceral causes
ABDOMINAL
gall stone
kidney stones
infections
tumours
GYNECOLOGY
cysts/tumours
fibroma
infections
ectopic pregnancy
UROGENITAL
infection
prostate
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rED FLAGSAge < 20 or >55
Non-mechanical pain
Night pains
Previous cancer, steroid use
Weight loss
Bad general condition
Thoracic pain
Trauma
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“Harry”
68 year old
Back and bilateral leg pain
Symptoms for 12 months
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Spinal Stenosis
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Spinal stenosis
Subjective history findingLikelihood of stenosis after a negative responseStenosis prevalence 2%
Likelihood of stenosis after a negative responseStenosis prevalence 13%
1) Pain below the buttock? 0,67 % 4,97 %
2) Age over 65 years? 0,22 % 1,7 %
3) Symptoms relieved by sitting? 0,06 % 0,48 %
4) Symptoms provoked by walking? 0,02 % 0,16 %
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“Victor”
24 years old
Low Back and bilateral buttock pain
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Spondylolisthesis
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Spondylolisthesis
21 out of 936 asymptomatic individuals had spondylolistesis (Libson 1982)
Spondylolisthesis associated with 25% greater risk of LBP (Grosser 1996)
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Spondylolisthesis
X-Ray to exclude
Functional X-Ray to determine instability
MRI to examine nerve root affection
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“Matt”
37 years old
Severe back pains
Disturbed sleep, wakes up towards the morning.
Difficult to take care of work as a banker
Back feels stiff
Very tired
Slow onset
Improves when gardening
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Inflammatory Back pain
4 out of 5:
Onset of back pain before the age of 40.
Insidous onset.
Improves after activity.
No improvement with rest.
Night pains that eases when the patients gets out of bed.
Family history
Psoriasis
Crohns/Collitis
HLAB-27
“Tendinitis”
Swollen finger/toe
Blood tests
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Inflammatory Back pain
Less than10/12 cm
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Inflammatory Back pain
STIR MRI
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“lizzy”
78 years old
Acute onset back pain 4 days ago while gardening
Constant pain
Radiating into the thigh
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Osteoporotic fracture
Sudden onset
Direct pain on vertebrae
Worse with walking, standing, sitting, moving
XRAYS - DEXA-scan
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Osteoporisis - Risk
Woman (every 3rd woman, every 8th male)
Early menopause (<45 years)
Family history
Steroid treatment >5 mg daily and/or more than 3 months
Tobacco/alcohol use
Low body weight
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“Eric”
52 year old cab driver
Sharp back pain for 1 month
Radiating into left thigh
Constant pain
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“Eric”
Pain on percussion of vertebrae
Bad general condition
Severe pain in left groin
Sweating
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Infection
Generally unwell
Previous infection or surgical procedure
Discitis or Epidural abcess
PSOAS ABCESS
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“Eliza”
70 years old
Low Back Pain 4 months ago
Slow onset, no specific cause
No previous back pain episodes
WHATS YOUR PLAN?
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Age
Previous history
General health
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Blood tests
Infection, inflammation
Affection of kidney or urinary system
Bones (fracture, inflammation, cancer)
Prostate
Other
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Spinal tumours
Most often metastases 25:1
Chest, prostate, lungs, kidney, colon.
Thoracic pain
Night pains
Constant pain
Weight loss 5-10% over 3-6 months
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Xrays - MRI
Individuals WITH NO symptoms
Stenosis 21 %
Spondylolisthesis 2 %
Disc prolapse 36 %
“Degenerative changes” 80 %
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Remember this...