Back pain physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
[[Patients]] with [[back]] [[pain]] have variable presentation depending on the severity of [[pain]] and associated [[signs]] and [[symptoms]]. | [[Patients]] with [[back]] [[pain]] have variable presentation depending on the severity of [[pain]] and associated [[signs]] and [[symptoms]]. If [[fever]] is present then [[infectious]] cause should be investigated. [[Signs]] of [[trauma]] should be observed, including, [[contusions]], [[abrasions]], point tenderness. Restricted range of motion and muscular tenderness are observed in [[patients]] with [[lumbosacral]] [[muscle]] strains/[[sprains]]. [[Pain]] on extension and rotation of [[hips]] may be present in [[patients]] with [[lumbar spondylosis]] along with [[pain]] radiating to [[hips]]. [[Point tenderness]] can be seen in [[patients]] with vertebral compression [[fracture]]. [Genitourinary]] [[examination]] of [[patients]] with [[back]] [[pain]] is usually normal. However, if any [[abnormality]] is recognized further investigation must be done to rule-out a more serious condition. [[Paresthesia]], [[sensory]] deficit, decreased [[muscular]] strength or diminished reflexes may be observed in [[patients]] with herniated disc. [[Straight leg raise]] (SLR) should be done to investigate for [[lumbar disk herniation]]. [[Motor deficit]] in [[legs]] and [[sensory loss]] is also seen in [[patients]] with [[spinal stenosis]]. One leg hyperextension test looks for [[pars interarticularis defect]] as a cause of [[back]] [[pain]]. | ||
==Physical Examination== | ==Physical Examination== | ||
| Line 18: | Line 18: | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with [ | * [[Skin]] [[examination]] of [[patients]] with [[back]] [[pain]] is usually normal. | ||
* [[Signs]] of [[trauma]] should be observed, including, [[contusions]], [[abrasions]], point tenderness. | |||
*[[ | |||
===HEENT=== | ===HEENT=== | ||
* HEENT examination | * HEENT [[examination]] of [[patients]] with [[back]] [[pain]] is usually normal. | ||
===Neck=== | ===Neck=== | ||
* | * [[Neck]] [[examination]] of [[patients]] with [[back]] [[pain]] is usually normal. | ||
===Lungs=== | ===Lungs=== | ||
| Line 71: | Line 37: | ||
===Back=== | ===Back=== | ||
*Restricted range of motion and muscular | *Restricted range of motion and [[muscular]] tenderness are observed in [[patients]] with [[lumbosacral]] [[muscle]] strains/[[sprains]].<ref name="CasserSeddigh2016">{{cite journal|last1=Casser|first1=Hans-Raimund|last2=Seddigh|first2=Susann|last3=Rauschmann|first3=Michael|title=Acute Lumbar Back Pain: Investigation, Differential Diagnosis, and Treatment|journal=Deutsches Aerzteblatt Online|year=2016|issn=1866-0452|doi=10.3238/arztebl.2016.0223}}</ref> | ||
*[[Pain]] on extension and rotation of [[hips]] may be present in [[patients]] with [[lumbar spondylosis]] along with [[pain]] radiating to [[hips]].<ref name="MiddletonFish2009">{{cite journal|last1=Middleton|first1=Kimberley|last2=Fish|first2=David E.|title=Lumbar spondylosis: clinical presentation and treatment approaches|journal=Current Reviews in Musculoskeletal Medicine|volume=2|issue=2|year=2009|pages=94–104|issn=1935-973X|doi=10.1007/s12178-009-9051-x}}</ref> | *[[Pain]] on extension and rotation of [[hips]] may be present in [[patients]] with [[lumbar spondylosis]] along with [[pain]] radiating to [[hips]].<ref name="MiddletonFish2009">{{cite journal|last1=Middleton|first1=Kimberley|last2=Fish|first2=David E.|title=Lumbar spondylosis: clinical presentation and treatment approaches|journal=Current Reviews in Musculoskeletal Medicine|volume=2|issue=2|year=2009|pages=94–104|issn=1935-973X|doi=10.1007/s12178-009-9051-x}}</ref> | ||
*[[Point tenderness]] can be seen in [[patients]] with vertebral compression [[fracture]]. | |||
===Genitourinary=== | ===Genitourinary=== | ||
| Line 79: | Line 46: | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*[[Paresthesia]], [[sensory]] deficit, decreased [[muscular]] strength or diminished reflexes may be observed in [[patients]] with herniated disc. | *[[Paresthesia]], [[sensory]] deficit, decreased [[muscular]] strength or diminished reflexes may be observed in [[patients]] with herniated disc. | ||
* | *[[Motor deficit]] in [[legs]] and [[sensory loss]] is also seen in [[patients]] with [[spinal stenosis]]. | ||
===Extremities=== | ===Extremities=== | ||
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* [[Straight leg raise]] (SLR) should be done to investigate for [[lumbar disk herniation]].<ref name="pmid1386391">{{cite journal| author=Deyo RA, Rainville J, Kent DL| title=What can the history and physical examination tell us about low back pain? | journal=JAMA | year= 1992 | volume= 268 | issue= 6 | pages= 760-5 | pmid=1386391 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386391 }} </ref> | * [[Straight leg raise]] (SLR) should be done to investigate for [[lumbar disk herniation]].<ref name="pmid1386391">{{cite journal| author=Deyo RA, Rainville J, Kent DL| title=What can the history and physical examination tell us about low back pain? | journal=JAMA | year= 1992 | volume= 268 | issue= 6 | pages= 760-5 | pmid=1386391 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386391 }} </ref> | ||
* One leg hyperextension test looks for [[pars interarticularis defect]] as a cause of [[back]] [[pain]].<ref name="pmid28795014">{{cite journal| author=Patel DR, Kinsella E| title=Evaluation and management of lower back pain in young athletes. | journal=Transl Pediatr | year= 2017 | volume= 6 | issue= 3 | pages= 225-235 | pmid=28795014 | doi=10.21037/tp.2017.06.01 | pmc=5532202 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28795014 }} </ref> | * One leg hyperextension test looks for [[pars interarticularis defect]] as a cause of [[back]] [[pain]].<ref name="pmid28795014">{{cite journal| author=Patel DR, Kinsella E| title=Evaluation and management of lower back pain in young athletes. | journal=Transl Pediatr | year= 2017 | volume= 6 | issue= 3 | pages= 225-235 | pmid=28795014 | doi=10.21037/tp.2017.06.01 | pmc=5532202 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28795014 }} </ref> | ||
*Look for [[signs]] of [[IV]] [[drug]] [[abuse]]. | |||
==References== | ==References== | ||
Latest revision as of 05:04, 8 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Patients with back pain have variable presentation depending on the severity of pain and associated signs and symptoms. If fever is present then infectious cause should be investigated. Signs of trauma should be observed, including, contusions, abrasions, point tenderness. Restricted range of motion and muscular tenderness are observed in patients with lumbosacral muscle strains/sprains. Pain on extension and rotation of hips may be present in patients with lumbar spondylosis along with pain radiating to hips. Point tenderness can be seen in patients with vertebral compression fracture. [Genitourinary]] examination of patients with back pain is usually normal. However, if any abnormality is recognized further investigation must be done to rule-out a more serious condition. Paresthesia, sensory deficit, decreased muscular strength or diminished reflexes may be observed in patients with herniated disc. Straight leg raise (SLR) should be done to investigate for lumbar disk herniation. Motor deficit in legs and sensory loss is also seen in patients with spinal stenosis. One leg hyperextension test looks for pars interarticularis defect as a cause of back pain.
Physical Examination
Physical examination of patients with back pain depends on the underlying etiology and severity.
Appearance of the Patient
Vital Signs
- Vital signs are usually normal.
- If fever is present then infectious cause should be investigated.
Skin
- Skin examination of patients with back pain is usually normal.
- Signs of trauma should be observed, including, contusions, abrasions, point tenderness.
HEENT
- HEENT examination of patients with back pain is usually normal.
Neck
- Neck examination of patients with back pain is usually normal.
Lungs
- Pulmonary examination of patients with back pain is usually normal.
Heart
- Cardiovascular examination of patients with back pain is usually normal.
Abdomen
- Abdominal examination of patients with back pain is usually normal.
Back
- Restricted range of motion and muscular tenderness are observed in patients with lumbosacral muscle strains/sprains.[1]
- Pain on extension and rotation of hips may be present in patients with lumbar spondylosis along with pain radiating to hips.[2]
- Point tenderness can be seen in patients with vertebral compression fracture.
Genitourinary
- Genitourinary examination of patients with back pain is usually normal. However, if any abnormality is recognized further investigation must be done to rule-out a more serious condition.
Neuromuscular
- Paresthesia, sensory deficit, decreased muscular strength or diminished reflexes may be observed in patients with herniated disc.
- Motor deficit in legs and sensory loss is also seen in patients with spinal stenosis.
Extremities
- Extremities examination is usually normal or could show signs of trauma if that is the cause of back pain.
- Straight leg raise (SLR) should be done to investigate for lumbar disk herniation.[3]
- One leg hyperextension test looks for pars interarticularis defect as a cause of back pain.[4]
- Look for signs of IV drug abuse.
References
- ↑ Casser, Hans-Raimund; Seddigh, Susann; Rauschmann, Michael (2016). "Acute Lumbar Back Pain: Investigation, Differential Diagnosis, and Treatment". Deutsches Aerzteblatt Online. doi:10.3238/arztebl.2016.0223. ISSN 1866-0452.
- ↑ Middleton, Kimberley; Fish, David E. (2009). "Lumbar spondylosis: clinical presentation and treatment approaches". Current Reviews in Musculoskeletal Medicine. 2 (2): 94–104. doi:10.1007/s12178-009-9051-x. ISSN 1935-973X.
- ↑ Deyo RA, Rainville J, Kent DL (1992). "What can the history and physical examination tell us about low back pain?". JAMA. 268 (6): 760–5. PMID 1386391.
- ↑ Patel DR, Kinsella E (2017). "Evaluation and management of lower back pain in young athletes". Transl Pediatr. 6 (3): 225–235. doi:10.21037/tp.2017.06.01. PMC 5532202. PMID 28795014.