Back pain: Pathology review

9,787views

00:00 / 00:00

Questions

USMLE® Step 1 style questions USMLE

of complete

A 30-year-old male comes to the physician due to back pain. 2 months ago, he started having back pains which he attributed to the strenuous interval training he attended at that time. The patient discloses morning pain and stiffness which improves after his morning exercise routine. The pain often awakes him at night, but he is able to go back to sleep. On physical examination, pain is reproduced with palpation of the sacroiliac joint and spinal flexion is limited. Estimated erythrocyte sedimentation rate is 75 mm/hr. This patient’s condition is also associated with which of the following?

Transcript

Watch video only

At the urgent care clinic, three people came in with lower back pain. The first is Jeff, a 26-year-old, who says his pain began 5 hours ago after trying to lift a 300-pound weight off of the floor at his local gym. He describes the pain as sharp and severe and says the pain goes down the back of his right leg and into his foot. Physical examination reveals a positive straight leg raise test on the right, and a diminished right Achilles tendon reflex. Second is Beth, a 68-year-old, who says she slipped and fell while walking in her kitchen yesterday. Her history includes a wrist fracture from a little over a year ago. Physical examination shows midline spinal tenderness to palpation. Finally, we have Harry, a 71-year-old male, who says his back pain has progressively worsened over the past month, keeping him up at night. He also reports increased urinary frequency.

Back pain is a very common complaint and one for which there are many potential causes. It can originate from the spinal cord, nerve roots, the vertebral column, the surrounding muscles, and ligaments, or even extra-spinal structures, such as abdominal organs. Therefore, the causes of back pain can be subdivided into mechanical causes, such as muscle strain, spinal osteoarthritis, disc herniation, spinal stenosis, vertebral fractures and osteoporosis; and non-mechanical causes, such as bone metastasis, seronegative spondyloarthritis, and vertebral osteomyelitis.

First, let’s start with musculoskeletal causes. The vast majority of cases of back pain are considered non-specific musculoskeletal pain due to strained muscles or ligaments. These individuals have no sensory or motor deficits, and they typically complain about tenderness over the affected muscle or ligament. The treatment for these individuals is prescribing activity as tolerated and NSAIDs for pain management. The next one is spinal osteoarthritis, which can be due to the natural aging process where the cartilage at the tips of bones wear down over their lifetime. It is associated with joint degeneration, ligamentous changes, disc degeneration, and finally, deformity of the spine.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "In the clinic. Low back pain" Ann Intern Med (2014)
  4. "Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment" Curr Pain Headache Rep (2019)
  5. "Incidence and prognosis of mid-back pain in the general population: A systematic review" European Journal of Pain (2016)
  6. "Lumbosacral Radiculopathy" Neurologic Clinics (2007)
  7. " Radicular Pain Syndromes: Cervical, Lumbar, and Spinal Stenosis" Semin Neurol (2018)
  8. "The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature" The Spine Journal (2014)
  9. "Diagnosis and Management of Vertebral Compression Fractures" Am Fam Physician (2016)
  10. "Epidemiology of Vertebral Fractures" Journal of Clinical Densitometry (2016)
  11. "Vertebral osteomyelitis in adults: an update" British Medical Bulletin (2016)
  12. "Clinical management of spinal metastases-The Dutch national guideline" Eur J Cancer (2018)
  13. "2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults" Clinical Infectious Diseases (2015)
  14. "Ankylosing Spondylitis and Axial Spondyloarthritis" N Engl J Med (2016)
  15. "The Seronegative Spondyloarthropathies" Prim Care (2018)
Elsevier

Copyright © 2024 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.

RELX