Back pain (red flags): Difference between revisions
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== | ==General == | ||
===History=== | ===History=== | ||
#Pain > | #Pain >6wk (tumor, infection) | ||
#Age >50<18 | #Age >50 or <18 (tumor, congenital anomaly) | ||
# | #History of trauma | ||
# | #History of IVDU | ||
#History of cancer | |||
#History of sciatica | |||
#Neurological complaints (paresthesias, anesthesia, weakness) | #Neurological complaints (paresthesias, anesthesia, weakness) | ||
#Incontinence of bowel | #Incontinence of bowel/bladder | ||
#Night pain | #Night pain | ||
# | #Unremitting pain, even when supine | ||
#Fever, chills, night sweats | #Fever, chills, night sweats | ||
# | #Anticoagulants/coagulopathy | ||
===Physical Exam=== | ===Physical Exam=== | ||
#Fever | #Fever | ||
#Pt writhing in pain | #Pt writhing in pain | ||
#Anal sphincter laxity | |||
#Parianal/perineal sensory loss | |||
#Palpable bladder postvoiding | |||
#Point vertebral tenderness | #Point vertebral tenderness | ||
#Neurological deficits | #Neurological deficits | ||
#Positive | #Positive straight leg raise | ||
==Specific Condition Red Flags== | ==Specific Condition Red Flags== | ||
===Cancer Related=== | ===Cancer Related=== | ||
# | #History of back pain | ||
#Weight loss>10kg in | #Weight loss >10kg in 6mo | ||
#Age>50 <18 | #Age >50 or <18 | ||
#No improvement despite therapy | #No improvement despite therapy | ||
#Pain for 4- | #Pain for >4-6wks | ||
#Night pain | #Night pain | ||
#Pain worse at rest | #Pain worse at rest | ||
| Line 36: | Line 40: | ||
#Recent infection | #Recent infection | ||
#Immunocompromised state | #Immunocompromised state | ||
## Systemic | ##HIV | ||
## Transplant | ##Systemic corticosteroids | ||
## | ##Transplant | ||
##DM | |||
===Cauda Equina=== | ===Cauda Equina=== | ||
| Line 57: | Line 62: | ||
#History of osteoporosis | #History of osteoporosis | ||
#Age>70 | #Age>70 | ||
#Mild trauma in age > | #Mild trauma in age >50yr | ||
#Significant trauma in any age | #Significant trauma in any age | ||
#Bony tenderness | #Bony tenderness | ||
| Line 65: | Line 70: | ||
#Pulsating mass | #Pulsating mass | ||
#Pain at rest or at night | #Pain at rest or at night | ||
#Age > | #Age >60yrs | ||
==See Also== | ==See Also== | ||
[[Lower Back Pain]] | [[Lower Back Pain]] | ||
==Source== | |||
*Tintinalli | |||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 00:55, 18 February 2012
General
History
- Pain >6wk (tumor, infection)
- Age >50 or <18 (tumor, congenital anomaly)
- History of trauma
- History of IVDU
- History of cancer
- History of sciatica
- Neurological complaints (paresthesias, anesthesia, weakness)
- Incontinence of bowel/bladder
- Night pain
- Unremitting pain, even when supine
- Fever, chills, night sweats
- Anticoagulants/coagulopathy
Physical Exam
- Fever
- Pt writhing in pain
- Anal sphincter laxity
- Parianal/perineal sensory loss
- Palpable bladder postvoiding
- Point vertebral tenderness
- Neurological deficits
- Positive straight leg raise
Specific Condition Red Flags
Cancer Related
- History of back pain
- Weight loss >10kg in 6mo
- Age >50 or <18
- No improvement despite therapy
- Pain for >4-6wks
- Night pain
- Pain worse at rest
- Vertebral tenderness
Infection Related
- Persistent fever
- History of IVDA
- Recent infection
- Immunocompromised state
- HIV
- Systemic corticosteroids
- Transplant
- DM
Cauda Equina
- Incontinence or retention
- Saddle anesthesia
- Decreased anal sphincter tone
- Bilateral lower extremity weakness or numbness
- Neurologic deficit
Herniated Disc
- Muscle Weakness
- Radiation of pain
- Footdrop
Vertebral Fracture
- Prolonged use of corticosteroids
- History of osteoporosis
- Age>70
- Mild trauma in age >50yr
- Significant trauma in any age
- Bony tenderness
AAA
- Risk factors for PVD
- Pulsating mass
- Pain at rest or at night
- Age >60yrs
See Also
Source
- Tintinalli