Diagnostic work-up for acute back pain. Initial assessment of back pain consists of a history and physical examination. Important characterizing features of the back pain include location, duration, severity, history of prior back pain, and possible trauma. Other important components of the patient history include age, physical trauma, prior history of cancer, fever, weight loss, urinary incontinence, progressive weakness, or expanding sensory changes, which can elicit red flags indicating a medically urgent condition. Physical examination of the back should assess for posture and deformities. Pain elicited by palpating certain structures may be helpful in localizing the affected area. A neurologic exam is needed to assess for changes in gait, sensation, and motor function. Determining if there are radicular symptoms, such as pain, numbness, or weakness that radiate down limbs, is important for differentiating between central and peripheral causes of back pain. The straight leg test is a maneuver used to determine the presence of lumbosacral radiculopathy. Radiculopathy occurs when there is irritation in the nerve root, causing neurologic symptoms, such as numbness and tingling. Non-radicular back pain is most commonly caused by injury to the spinal muscles or ligaments, degenerative spinal disease, or a herniated disk. Disk herniation and foraminal stenosis are the most common causes of radiculopathy. Imaging of the spine and laboratory tests is not recommended during the acute phase. This assumes that there is no reason to expect that the person has an underlying problem. In most cases, the pain goes away naturally after a few weeks. Typically, people who do seek diagnosis through imaging are not likely to have a better outcome than those who wait for the condition to resolve. Imaging Magnetic resonance imaging is the preferred modality for the evaluation of back pain and visualize bone, soft tissue, nerves, and ligaments. X-rays are a less costly initial option offered to patients with a low clinical suspicion of infection or malignancy and is combined with laboratory studies for interpretation. Imaging is not needed in the majority of individuals with back pain. In cases of acute back pain, MRI is recommended for individuals with major risk factors/clinical suspicion for cancer, spinal infection, or severe progressive neurological deficits. For patients with subacute to chronic back pain, MRI is recommended if there are minor risk factors for cancer, risk factors for ankylosing spondylitis, risk factors for vertebral compression fracture, significant trauma, or symptomatic spinal stenosis. Early imaging studies during the acute phase do not improve care or prognosis in patients. Imaging findings are not correlated with severity or outcome. Laboratory studies Laboratory studies are used to if there are suspicions for autoimmune causes, infection, or malignancy. Laboratory testing may include white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). * Elevated ESR could indicate infection, malignancy, chronic disease, inflammation, trauma, or tissue ischemia. * Elevated CRP levels are associated with infection. CT scan of the spine, showing calcification of the longitudinal posterior ligament. Red flags Imaging is not typically needed in the initial diagnosis or treatment of back pain. However, if there are certain "red flag" symptoms present plain radiographs (x-ray), CT scan, or magnetic resonance imaging (MRI) may be recommended. These red flags include: * History of cancer * Unexplained weight loss * Immunosuppression * Urinary infection * Intravenous drug use * Prolonged use of corticosteroids * Back pain not improved with conservative management * History of significant trauma * Minor fall or heavy lift in a potentially osteoporotic or elderly individual * Acute onset of urinary retention, overflow incontinence, loss of anal sphincter tone, or fecal incontinence * Saddle anesthesia * Global or progressive motor weakness in the lower limbs
complications of Achondroplasia
complications of Prader–Willi syndrome
complications of Noonan syndrome
complications of Treacher Collins syndrome
complications of Kallmann syndrome
complications of Nuchal cord
symptom of Achondroplasia
onset of Klippel–Feil syndrome