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Causes of Back conditions
Causes of Back conditions: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Back conditions.
Low Back Pain/Swelling:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Lumbosacral muscle strain
–Most common etiology of low back pain
–Most common cause of disability in adults <45 years old
–Aggravated by movement, better with rest -
Lumbar disc herniation
–Especially of L4-L5 and L5-S1
–Usually with unilateral radiation down the leg in a dermatomal pattern
–Increased pain with sitting- Spinal stenosis
–Back and bilateral buttock and thigh pain in older patients relieved by rest (pseudoclaudication)
–Increased pain with standing -
Sacral-iliac joint dysfunction
–Especially in young, thin women or in pregnancy
–Unilateral upper buttock pain, relieved with movement -
Vertebral fracture
–Often associated with trauma or osteoporosis -
Spondylolisthesis
–Especially in young athletes - Secondary gain (e.g., drug seeking, disability or liability issue)
- Extraspinal causes (e.g., radiation from kidney stones)
- Systemic causes (<1%)
–Inflammation (e.g., ankylosing spondylitis): Morning stiffness, limited mobility
–Infection: Osteomyelitis, abscess
–Abdominal aortic aneurysm
–Cancer (especially metastases from prostate, lung, colon, and breast or myeloma); constant, worsening pain, wakes up from sleep
–Cauda equina syndrome
–Paget's disease
- Spinal stenosis
Source: In a Page: Signs and Symptoms, 2004
Scoliosis & Kyphosis:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Scoliosis
- Idiopathic (75–80% of cases) scoliosis usually occurs in otherwise healthy patients; pain and neurologic deficits are rare; right thoracic curve is most common, then double curve (right thoracic and left lumbar); named by convex side
–Infantile (birth to 3 years): Rare in the U.S.
–Juvenile (4–10 years): Uncommon
–Adolescent (11 years to skeletal maturity): Occurs mostly in females
-
Neuromuscular scoliosis
–Common with paralytic disorders
–More severe, almost always progressive -
Congenital scoliosis
–Failure of formation or segmentation - Postural roundback
-
Scheuermann's disease
–Second most common pediatric spinal deformity
–Cannot voluntarily correct
–Angulation in mid- to low-thoracic spine -
Congenital kyphosis
Less common etiologies (“zebras”) - Post-thoracotomy
- Marfan's syndrome
- Neurofibromatosis
- Achondroplasia
- Diastrophic dwarfism
- Specific neuromuscular disorders (e.g., cerebral palsy, syringomyelia, polio, muscular dystrophy, cord tumor/trauma)
Kyphosis
Source: In a Page: Signs and Symptoms, 2004
Back Pain:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Muscular strain, disk herniation
–Most common in adolescents who are involved in competitive or contact sports; may be occupational -
Spondyloarthropathy
–Ankylosing spondylitis is found primarily in boys, characterized by sacroiliitis, LE oligoarthritis, and may be associated with IBD- Malalignment
–Scoliosis: Idiopathic form is most common in girls, may be familial, may be secondary to neurologic disorder
–Hyperlordosis
- Infectious
–Diskitis: Characterized by spine stiffness and muscular spasm, Staphylococcus aureus is the usual pathogen, blood culture may be positive
–Vertebral osteomyelitis: Exquisite point tenderness, pathogen may be S. aureus, Streptococcus pneumoniae, or others such as tuberculosis or brucellosis
–Acute transverse myelopathy: Generally follows an upper respiratory tract infection; characterized by back pain, distal weakness and paresthesias at the midthoracic level
- Urinary tract
–Urinary tract infection: Most common in postpubertal girls, occurrence in boys or prepubertal girls may require evaluation for urinary tract anomalies, especially if recurrent
–Urolithiasis: Associated with hypercalcuria, cystinuria, Lesch-Nyhan; characterized by intense flank pain and hematuria
- Malignancy
–Primary spinal cord or column tumors (osteogenic sarcoma, neuroblastoma)
–Metastatic tumors (neuroblastoma)
–Bone marrow infiltration (leukemia, lymphoma)
- Gynecologic
–Menstrual cramps
–PID
–Endometriosis
- Malalignment
Source: In A Page: Pediatric Signs and Symptoms, 2007
Scoliosis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Idiopathic scoliosis
–Lateral deviation or curvature of either the thoracic or lumbar spine greater than 10°
–Right thoracic curves are most common
–Usually presents in early adolescence
–Girls > boys -
Risk factors for progression
–Curve >20°
–Age less than 12
–Skeletal maturity, Risser stage 0–1 -
Infantile idiopathic scoliosis
–Presents at 0–3 years old
–Left thoracic curve more common
–Boys > girls
–85% spontaneously resolve
–Must rule out spinal cord disease or congenital cause of scoliosis - Juvenile idiopathic scoliosis presents at 3–10 years old and is similar to adolescent (idiopathic) scoliosis
- Neuromuscular scoliosis
–Related to cerebral palsy, muscular dystrophy, myotonic myopathy, and spinal muscular atrophy
–Tends to progress more rapidly and even continues after maturity, as compared to idiopathic scoliosis
–Pulmonary complications seen with severe curves >90°
-
Congenital scoliosis
–Failure of formation or segmentation of spinal vertebra
–Rapid progression and worse prognosis is associated with unilateral unsegmented bar with contralateral hemivertebra -
Other causes
–Tumor, infection, neurofibromatosis, metabolic bone disorders, and Marfan syndrome
Source: In A Page: Pediatric Signs and Symptoms, 2007
Back pain:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Abdominal aortic aneurysm (dissecting). Life-threatening dissection of this aneurysm may initially cause low back pain or dull abdominal pain. More commonly, it produces constant upper abdominal pain. A pulsating abdominal mass may be palpated in the epigastrium; after rupture, however, it no longer pulses. Aneurysmal dissection can also cause mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock (such as cool, clammy skin) appear if blood loss is significant.
❑ Ankylosing spondylitis. Ankylosing spondylitis is a chronic, progressive disorder that causes sacroiliac pain, which radiates up the spine and is aggravated by lateral pressure on the pelvis. The pain is usually most severe in the morning or after a period of inactivity and isn't relieved by rest. Abnormal rigidity of the lumbar spine with forward flexion is also characteristic. This disorder can cause local tenderness, fatigue, fever, anorexia, weight loss, and occasional iritis.
❑ Appendicitis. Appendicitis is a life-threatening disorder in which a vague and dull discomfort in the epigastric or umbilical region migrates to McBurney's point in the right lower quadrant. With retrocecal appendicitis, pain may also radiate to the back. The shift in pain is preceded by anorexia and nausea and is accompanied by fever, occasional vomiting, abdominal tenderness (especially over McBurney's point), and rebound tenderness. Some patients also have painful, urgent urination.
❑ Cholecystitis. Cholecystitis produces severe pain in the right upper quadrant of the abdomen that may radiate to the right shoulder, chest, or back. The pain may arise suddenly or may increase gradually over several hours, and patients usually have a history of similar pain after a high-fat meal. Accompanying signs and symptoms include anorexia, fever, nausea, vomiting, right upper quadrant tenderness, abdominal rigidity, pallor, and sweating.
❑ Chordoma. A slow-developing malignant tumor, chordoma causes persistent pain in the lower back, sacrum, and coccyx. As the tumor expands, pain may be accompanied by constipation and bowel or bladder incontinence.
❑ Endometriosis. Endometriosis causes deep sacral pain and severe, cramping pain in the lower abdomen. The pain worsens just before or during menstruation and may be aggravated by defecation. It's accompanied by constipation, abdominal tenderness, dysmenorrhea, and dyspareunia.
❑ Intervertebral disk rupture. Intervertebral disk rupture produces gradual or sudden low back pain with or without leg pain (sciatica). It rarely produces leg pain alone. Pain usually begins in the back and radiates to the buttocks and leg. The pain is exacerbated by activity, coughing, and sneezing and is eased by rest. It's accompanied by paresthesia (most commonly, numbness or tingling in the lower leg and foot), paravertebral muscle spasm, and decreased reflexes on the affected side. This disorder also affects posture and gait. The patient's spine is slightly flexed and he leans toward the painful side. He walks slowly and rises from a sitting to a standing position with extreme difficulty.
❑ Lumbosacral sprain. Lumbosacral sprain causes aching, localized pain and tenderness associated with muscle spasm on lateral motion. The recumbent patient typically flexes his knees and hips to help ease pain. Flexion of the spine intensifies pain, whereas rest helps relieve it. The pain worsens with movement and is relieved by rest.
❑ Metastatic tumors. Metastatic tumors commonly spread to the spine, causing low back pain in at least 25% of patients. Typically, the pain begins abruptly, is accompanied by cramping muscular pain (usually worse at night), and isn't relieved by rest.
❑ Myeloma. Back pain caused by myeloma, a primary malignant tumor, usually begins abruptly and worsens with exercise. It may be accompanied by arthritic signs and symptoms, such as achiness, joint swelling, and tenderness. Other signs and symptoms include fever, malaise, peripheral paresthesia, and weight loss.
❑ Pancreatitis (acute). Pancreatitis is a life-threatening disorder that usually produces fulminating, continuous upper abdominal pain that may radiate to both flanks and to the back. To relieve this pain, the patient may bend forward, draw his knees to his chest, or move restlessly about.
Early associated signs and symptoms include abdominal tenderness, nausea, vomiting, fever, pallor, tachycardia and, in some patients, abdominal guarding, rigidity, rebound tenderness, and hypoactive bowel sounds. A late sign may be jaundice. Occurring as inflammation subsides, Turner's sign (ecchymosis of the abdomen or flank) or Cullen's sign (bluish discoloration of skin around the umbilicus and in both flanks) signals hemorrhagic pancreatitis.
❑ Perforated ulcer. In some patients, perforation of a duodenal or gastric ulcer causes sudden, prostrating epigastric pain that may radiate throughout the abdomen and to the back. This life-threatening disorder also causes boardlike abdominal rigidity, tenderness with guarding, generalized rebound tenderness, the absence of bowel sounds, and grunting, shallow respirations. Associated signs include fever, tachycardia, and hypotension.
❑ Prostate cancer. Chronic aching back pain may be the only symptom of prostate cancer. This disorder may also produce hematuria and decrease the urine stream.
❑ Pyelonephritis (acute). Pyelonephritis produces progressive flank and lower abdominal pain accompanied by back pain or tenderness (especially over the costovertebral angle). Other signs and symptoms include high fever and chills, nausea and vomiting, flank and abdominal tenderness, and urinary frequency and urgency.
❑ Renal calculi.The colicky pain of renal calculi usually results from irritation of the ureteral lining, which increases the frequency and force of peristaltic contractions. The pain travels from the costovertebral angle to the flank, suprapubic region, and external genitalia. Its intensity varies but may become excruciating if calculi travel down a ureter. If calculi are in the renal pelvis and calyces, dull and constant flank pain may occur. Renal calculi also cause nausea, vomiting, urinary urgency (if a calculus lodges near the bladder), hematuria, and agitation due to pain. Pain resolves or significantly decreases after calculi move to the bladder. Encourage the patient to recover the calculi for analysis.
❑ Rift Valley fever. Rift Valley fever is a viral disease generally found in Africa, but recent outbreaks have occurred in Saudi Arabia and Yemen. It's transmitted to humans from the bite of an infected mosquito or from exposure to infected animals. Rift Valley fever may present as several different clinical syndromes. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.
❑ Sacroiliac strain. Sacroiliac strain causes sacroiliac pain that may radiate to the buttock, hip, and lateral aspect of the thigh. The pain is aggravated by weight bearing on the affected extremity and by abduction with resistance of the leg. Associated signs and symptoms include tenderness of the symphysis pubis and a limp or gluteus medius or abductor lurch.
❑ Smallpox (variola major). Worldwide eradication of smallpox was achieved in 1977; the United States and Russia have the only known storage sites of the virus. The virus is considered a potential agent for biological warfare. Initial signs and symptoms include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, and later the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.
❑ Spinal neoplasm (benign).Spinal neoplasm typically causes severe, localized back pain and scoliosis.
❑ Spinal stenosis. Resembling a ruptured intervertebral disk, spinal stenosis produces back pain with or without sciatica, which commonly affects both legs. The pain may radiate to the toes and may progress to numbness or weakness unless the patient rests.
❑ Spondylolisthesis. A major structural disorder characterized by forward slippage of one vertebra onto another, spondylolisthesis may be asymptomatic or may cause low back pain, with or without nerve root involvement. Associated symptoms of nerve root involvement include paresthesia, buttock pain, and pain radiating down the leg. Palpation of the lumbar spine may reveal a “step-off” of the spinous process. Flexion of the spine may be limited.
❑ Transverse process fracture. Transverse process fracture causes severe localized back pain with muscle spasm and hematoma.
❑ Vertebral compression fracture. Initially, vertebral compression fracture may be painless. Several weeks later, it causes back pain aggravated by weight bearing and local tenderness. Fracture of a thoracic vertebra may cause referred pain in the lumbar area.
❑ Vertebral osteomyelitis. Initially, vertebral osteomyelitis causes insidious back pain. As it progresses, the pain may become constant, more pronounced at night, and aggravated by spinal movement. Accompanying signs and symptoms include vertebral and hamstring spasms, tenderness of the spinous processes, fever, and malaise.
❑ Vertebral osteoporosis. Vertebral osteoporosis causes chronic, aching back pain that is aggravated by activity and somewhat relieved by rest. Tenderness may also occur.
Other causes
❑ Neurologic tests. Lumbar puncture and myelography can produce transient back pain.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Scoliosis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Scoliosis may be functional, structural, or idiopathic. Functional (postural) scoliosis usually results from a discrepancy in leg lengths rather than from a fixed deformity of the spinal column; it corrects when the patient bends toward the convex side. Structural scoliosis results from a deformity of the vertebral bodies, and it doesn’t correct when the patient bends to the side. Structural scoliosis may be:
❑ congenital: usually related to a congenital defect, such as wedge vertebrae, fused ribs or vertebrae, or hemivertebrae; may result from trauma to zygote or embryo
❑ paralytic or musculoskeletal: develops several months after asymmetrical paralysis of the trunk muscles due to polio, cerebral palsy, or muscular dystrophy
❑ idiopathic (the most common form): may be transmitted as an autosomal dominant or multifactorial trait. This form appears in a previously straight spine during the growing years. Brain stem dysfunction, possibly due to a lesion of the posterior columns or the inner ear, may be the cause.
Idiopathic scoliosis can be classified as infantile, which affects mostly male infants between birth and age 3 and causes left thoracic and right lumbar curves; juvenile, which affects both sexes between ages 4 and 10 and causes varying types of curvature; or adolescent, which generally affects girls between age 10 and achievement of skeletal maturity and causes varying types of curvature.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Back pain:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abdominal aortic aneurysm (dissecting)
Life-threatening dissection of an abdominal aortic aneurysm may initially cause low back pain or dull abdominal pain, but it usually produces constant upper abdominal pain. A pulsating abdominal mass may be palpated in the epigastrium; after rupture, though, it no longer pulsates. Aneurysm dissection can also cause mottled skin below the waist, absent femoral and pedal pulses, blood pressure that’s lower in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock (such as cool, clammy skin) appear if blood loss is significant.
Ankylosing spondylitis
Ankylosing spondylitis is a chronic, progressive disorder that causes sacroiliac pain, which radiates up the spine and is aggravated by lateral pressure on the pelvis. The pain is usually most severe in the morning or after a period of inactivity and isn’t relieved by rest. Abnormal rigidity of the lumbar spine with forward flexion is also characteristic. This disorder can cause local tenderness, fatigue, fever, anorexia, weight loss, and occasionally iritis.
Appendicitis
Appendicitis is a life-threatening disorder in which a vague and dull discomfort in the epigastric or umbilical region migrates to McBurney’s point in the right lower quadrant. In retrocecal appendicitis, pain may also radiate to the back. The shift in pain is preceded by anorexia and nausea and is accompanied by fever, occasional vomiting, abdominal tenderness (especially over McBurney’s point), and rebound tenderness. Some patients also have painful urinary urgency.
Cholecystitis
Cholecystitis produces severe pain in the right upper quadrant of the abdomen that may radiate to the right shoulder, chest, or back. The pain may arise suddenly or may increase gradually over several hours; many patients have a history of similar pain after a high-fat meal. Accompanying signs and symptoms include anorexia, fever, nausea, vomiting, right-upper-quadrant tenderness, abdominal rigidity, pallor, and sweating.
Chordoma
A slowly developing malignant tumor, chordoma causes persistent pain in the lower back, sacrum, and coccyx. As the tumor expands, pain may be accompanied by constipation and bowel or bladder incontinence.
Endometriosis
Endometriosis causes deep sacral pain and severe cramping pain in the lower abdomen. The pain worsens just before or during menstruation and may be aggravated by defecation. It’s accompanied by constipation, abdominal tenderness, dysmenorrhea, and dyspareunia.
Intervertebral disk rupture
Intervertebral disk rupture produces gradual or sudden low back pain with or without leg pain (sciatica). It rarely produces leg pain alone. Pain usually begins in the back and radiates to the buttocks and leg. The pain is exacerbated by activity, coughing, and sneezing and is eased by rest. It’s accompanied by paresthesia (most commonly, numbness or tingling in the lower leg and foot), paravertebral muscle spasm, and decreased reflexes on the affected side. This disorder also affects posture and gait. The patient’s spine is slightly flexed and he leans toward the painful side. He walks slowly and rises from a sitting to a standing position with extreme difficulty.
Lumbosacral sprain
Lumbosacral sprain causes localized aching pain and tenderness associated with muscle spasm on lateral motion. The recumbent patient typically flexes his knees and hips to help ease pain. Flexion of the spine and movement intensify the pain, whereas rest helps relieve it.
Metastatic tumors
Metastatic tumors commonly spread to the spine, causing low back pain in at least 25% of patients. Typically, the pain begins abruptly, is accompanied by cramping muscle pain (usually worse at night), and isn’t relieved by rest.
Myeloma
Back pain caused by myeloma—a primary malignant tumor— usually begins abruptly and worsens with exercise. It may be accompanied by arthritic signs and symptoms, such as achiness, joint swelling, and tenderness. Other signs and symptoms include fever, malaise, peripheral paresthesia, and weight loss.
Pancreatitis (acute)
Pancreatitis is a life-threatening disorder that usually produces fulminating, continuous upper abdominal pain that may radiate to both flanks and to the back. To relieve this pain, the patient may bend forward, draw his knees to his chest, or move about restlessly.
Early associated signs and symptoms include abdominal tenderness, nausea, vomiting, fever, pallor, and tachycardia; some patients experience abdominal guarding and rigidity, rebound tenderness, and hypoactive bowel sounds. Jaundice may be a late sign. Occurring as inflammation subsides, Turner’s sign (ecchymosis of the abdomen or flank) or Cullen’s sign (bluish discoloration of skin around the umbilicus and in both flanks) signals hemorrhagic pancreatitis.
Perforated ulcer
In some patients, perforation of a duodenal or gastric ulcer causes sudden, prostrating epigastric pain that may radiate throughout the abdomen and to the back. This life-threatening disorder also causes boardlike abdominal rigidity, tenderness with guarding, generalized rebound tenderness, absence of bowel sounds, and grunting, shallow respirations. Associated signs include fever, tachycardia, and hypotension.
Prostate cancer
Chronic aching back pain may be the only symptom of prostate cancer. This disorder may also cause hematuria and decreased urine stream.
Pyelonephritis (acute)
Pyelonephritis produces progressive flank and lower abdominal pain accompanied by back pain or tenderness (especially over the costovertebral angle). Other signs and symptoms include high fever and chills, nausea and vomiting, flank and abdominal tenderness, and urinary frequency and urgency.
Reiter’s syndrome
In some patients, sacroiliac pain is the first sign of Reiter’s syndrome. Pain is accompanied by the classic triad of conjunctivitis, urethritis, and arthritis.
Renal calculi
The colicky pain of renal calculi usually results from irritation of the ureteral lining, which increases the frequency and force of peristaltic contractions. The pain travels from the costovertebral angle to the flank, suprapubic region, and external genitalia. It varies in intensity but may become excruciating if calculi travel down a ureter. Calculi in the renal pelvis and calyces may cause dull and constant flank pain. Renal calculi also cause nausea, vomiting, urinary urgency (if a calculus lodges near the bladder), hematuria, and agitation due to pain. Pain resolves or significantly decreases after calculi move to the bladder. Encourage the patient to recover any expelled calculi for analysis.
Rift Valley fever
Rift Valley fever is a viral disease generally found in Africa, but recent outbreaks have occurred in Saudi Arabia and Yemen. It’s transmitted to humans from the bite of an infected mosquito or from exposure to infected animals. Rift Valley fever may present as several different clinical syndromes. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.
Sacroiliac strain
Sacroiliac strain causes sacroiliac pain that may radiate to the buttock, hip, and lateral aspect of the thigh. The pain is aggravated by weight bearing on the affected extremity and by abduction with resistance of the leg. Associated signs and symptoms include tenderness of the symphysis pubis and a limp or a gluteus medius or abductor lurch.
Smallpox (variola major)
Worldwide eradication of smallpox was achieved in 1977; the United States and Russia have the only known storage sites of the virus. The virus is considered a potential agent for biological warfare. Initial signs and symptoms include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the oral mucosa, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, which later separates from the skin, leaving a pitted scar. Death may result from encephalitis, extensive bleeding, or secondary infection.
Spinal neoplasm (benign)
Spinal neoplasm typically causes severe localized back pain and scoliosis.
Spinal stenosis
Resembling a ruptured intervertebral disk, spinal stenosis produces back pain with or without sciatica, which commonly affects both legs. The pain may radiate to the toes and may progress to numbness or weakness unless the patient rests.
Spondylolisthesis
A major structural disorder characterized by forward slippage of one vertebra onto another, spondylolisthesis may produce no symptoms or may cause low back pain with or without nerve root involvement. Associated symptoms of nerve root involvement include paresthesia, buttock pain, and pain radiating down the leg. Palpation of the lumbar spine may reveal a “step-off” of the spinous process. Flexion of the spine may be limited.
Transverse process fracture
This type of fracture causes severe localized back pain with muscle spasm and hematoma.
Vertebral compression fracture
A vertebral compression fracture may be painless initially. Several weeks later, it causes back pain aggravated by weight bearing and local tenderness. Fracture of a thoracic vertebra may cause referred pain in the lumbar area.
Vertebral osteomyelitis
Initially, vertebral osteomyelitis causes insidious back pain. As it progresses, the pain may become constant, more pronounced at night, and aggravated by spinal movement. Accompanying signs and symptoms include vertebral and hamstring spasms, tenderness of the spinous processes, fever, and malaise.
Vertebral osteoporosis
Vertebral osteoporosis causes chronic aching back pain that is aggravated by activity and somewhat relieved by rest. Tenderness may also occur.
Other causes
Neurologic tests
Lumbar puncture and myelography can produce transient back pain.
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Low Back Pain:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Musculoligamentous strain
❑ Lumbar disc herniation
❑ Osteoarthritis
❑ Compression fracture
❑ Pyelonephritis
❑ Secondary gain
❑ Scoliosis
❑ Spondylolisthesis
❑ Metastatic cancer
❑ Spinal stenosis
❑ Transverse process fracture
❑ Pancreatic cancer
❑ Ankylosing spondylitis
❑ Sacroiliitis
❑ Aortic dissection
❑ Cauda equina syndrome
❑ Vertebral osteomyelitis
❑ Epidural abscess
Source: Field Guide to Bedside Diagnosis, 2007
Scoliosis:
Causes
(Handbook of Diseases)
Scoliosis may be functional or structural. Functional (postural) scoliosis usually results from poor posture or a discrepancy in leg lengths, not fixed deformity of the spinal column. In structural scoliosis, curvature results from a deformity of the vertebral bodies.
Structural scoliosis may be one of three types:
❑ Congenital scoliosis is usually related to a congenital defect, such as wedge vertebrae, fused ribs or vertebrae, or hemivertebrae.
❑ Paralytic or musculoskeletal scoliosis develops several months after asymmetrical paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy.
❑ Idiopathic scoliosis (the most common form) may be transmitted as an autosomal dominant or multifactoral trait. This form appears in a previously straight spine during the growing years.
Idiopathic scoliosis can be classified as infantile, which affects mostly male infants between birth and age 3 and causes left thoracic and right lumbar curves; juvenile, which affects both sexes between ages 4 and 10 and causes varying types of curvature; or adolescent, which generally affects girls between age 10 and achievement of skeletal maturity and causes varying types of curvature.
Source: Handbook of Diseases, 2003
Back pain:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Abdominal aortic aneurysm (dissecting)
Life-threatening dissection of an abdominal aortic aneurysm may initially cause low back pain or dull abdominal pain. More commonly, it produces constant upper abdominal pain. A pulsating abdominal mass may be palpated in the epigastrium; pulsation ceases if rupture occurs. Aneurysmal dissection can also cause mottled skin below the waist, absence of femoral and pedal pulses, mild to moderate tenderness with guarding, and abdominal rigidity. Blood pressure in the patient’s legs may be lower than blood pressure in his arms. Signs of shock, such as cool, clammy skin, occur with significant blood loss.Ankylosing spondylitis
Ankylosing spondylitis is a chronic, progressive disorder that causes sacroiliac pain that radiates up the spine and is aggravated by lateral pressure on the pelvis. The pain is usually most severe in the morning or after a period of inactivity; it isn’t relieved by rest. Abnormal rigidity of the lumbar spine with forward flexion is also characteristic. Ankylosing spondylitis can cause local tenderness, fatigue, fever, anorexia, weight loss, and occasional iritis.Appendicitis
Appendicitis is a life-threatening disorder in which vague and dull discomfort in the epigastric or umbilical region gradually localizes in McBurney’s point in the right lower quadrant. With retrocecal appendicitis, pain may also radiate to the back. The localization of the pain is preceded by anorexia and nausea and is accompanied by fever, occasional vomiting, abdominal tenderness (especially over McBurney’s point), and rebound tenderness. Some patients also report painful, urgent urination.Cholecystitis
Cholecystitis produces severe pain that occurs in the right upper quadrant of the abdomen and may radiate to the right shoulder, chest, or back. The pain may occur abruptly or gradually, increasing over several hours. Patients typically report a history of similar pain after consuming high-fat meals. Accompanying signs and symptoms include anorexia, fever, nausea, vomiting, right upper quadrant tenderness, abdominal rigidity, pallor, and sweating.Chordoma
A slow-developing malignant tumor, chordoma causes persistent pain in the lower back, sacrum, and coccyx. As the tumor expands, pain may be accompanied by constipation and bowel or bladder incontinence.Endometriosis
Endometriosis causes deep sacral pain and severe, cramping pain in the lower abdomen. The pain worsens just before or during menstruation and may be aggravated by defecation. It’s accompanied by constipation, abdominal tenderness, dysmenorrhea, and dyspareunia.Intervertebral disk rupture
Disk rupture produces gradual or abrupt lower back pain with or without leg pain (sciatica). It rarely produces leg pain alone. Pain usually begins in the back and radiates to the buttocks and leg. It’s exacerbated by activity, coughing, and sneezing and lessened by rest. Accompanying symptoms include paresthesia (most commonly, numbness or tingling in the lower leg and foot), paravertebral muscle spasm, and decreased reflexes on the affected side. This disorder also affects posture and gait. The patient’s spine is slightly flexed and he leans toward the painful side. He walks slowly and rises from a sitting to a standing position with extreme difficulty.Lumbosacral sprain
Aching, localized pain and tenderness due to muscle spasm on lateral motion is the primary symptom of a lumbosacral sprain. The recumbent patient typically flexes his knees and hips to ease pain. Flexion of the spine intensifies pain, whereas rest facilitates relief.Metastatic tumors
The spread of metastatic tumors to the spine — a common occurrence — leads to low back pain in approximately 25% of patients. It typically begins abruptly and is accompanied by cramping muscular pain. This pain is usually worse at night and isn’t relieved by rest.Myeloma
Back pain caused by myeloma — a primary malignant tumor — usually begins abruptly and worsens with exercise. It may be accompanied by arthritic signs and symptoms, such as achiness, joint swelling, and tenderness. Other signs and symptoms include fever, malaise, peripheral paresthesia, and weight loss.Pancreatitis (acute)
Acute pancreatitis is a life-threatening disorder that typically produces fulminating, continuous upper abdominal pain that may radiate to both flanks and the back. To relieve this pain, the patient may bend forward, draw his knees to his chest, or move restlessly.Early associated signs and symptoms include abdominal tenderness, nausea, vomiting, fever, pallor, tachycardia and, in some patients, abdominal guarding, rigidity, rebound tenderness, and hypoactive bowel sounds. Jaundice may be a late sign. Occurring as inflammation subsides, Turner’s sign (ecchymosis of the abdomen or flank) or Cullen’s sign (bluish discoloration of skin around the umbilicus and in both flanks) signals hemorrhagic pancreatitis.
Perforated ulcer
In some patients, perforation of a duodenal or gastric ulcer causes sudden, prostrating epigastric pain that may radiate throughout the abdomen and to the back. This life-threatening disorder also causes boardlike abdominal rigidity, tenderness with guarding, generalized rebound tenderness, absent bowel sounds, and grunting, shallow respirations. Associated signs include fever, tachycardia, and hypotension.Prostate cancer
Chronic, aching back pain may be the only symptom of prostate cancer, although hematuria and decreased urine stream may also occur.Pyelonephritis (acute)
Acute pyelonephritis produces back pain or tenderness (especially over the CVA) as well as progressive pain in the flank and lower abdomen. Other signs and symptoms include high fever and chills, nausea and vomiting, flank and abdominal tenderness, and urinary frequency and urgency.Reiter’s syndrome
In some patients, sacroiliac pain is the first sign of Reiter’s syndrome. Pain is accompanied by the classic triad of conjunctivitis, urethritis, and arthritis.Renal calculi
The colicky pain of renal calculi usually results from irritation of the ureteral lining, which increases the frequency and force of peristaltic contractions. The pain travels from the CVA to the flank, suprapubic region, and external genitalia. Its intensity varies; it may become excruciating if calculi travel down a ureter. Calculi in the renal pelvis and calyces result in dull and constant flank pain. Renal calculi also cause nausea, vomiting, urinary urgency (if a calculus lodges near the bladder), hematuria, and agitation due to pain. Pain resolves or significantly decreases after calculi move to the bladder. Encourage the patient to recover the calculi for analysis.Rift Valley fever
Typical signs and symptoms of Rift Valley fever — a viral disease — include back pain, fever, myalgia, weakness, and dizziness. It may present as several different clinical syndromes. A small percentage of patients may develop encephalitis or hemorrhagic fever leading to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss. Although Rift Valley fever is typically found in Africa, outbreaks have also occurred in Saudi Arabia and Yemen. The disease is transmitted to humans through the bite of an infected mosquito or exposure to infected animals.Sacroiliac strain
Sacroiliac strain causes pain that may radiate to the buttock, hip, and lateral aspect of the thigh. The pain is aggravated by weight bearing on the affected extremity and by abduction with resistance of the leg. Associated signs and symptoms include tenderness of the symphysis pubis and a limp or a gluteus medius or abductor lurch.Smallpox (variola major)
Worldwide eradication of smallpox was achieved in 1977. The United States and Russia have the only documented storage sites of the virus, which is considered a potential agent for biological warfare. Initial signs and symptoms of smallpox include back pain, high fever, malaise, prostration, severe headache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and, later, pustular. The lesions, which develop simultaneously rather than gradually increasing in number, occur more frequently on the face and extremities. The pustules are round, firm, and embedded in the skin. After 8 to 9 days, the pustules form a crust. Later, the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.Spinal neoplasm (benign
).This neoplasm typically causes severe, localized back pain and scoliosis.Spinal stenosis
Resembling a ruptured intervertebral disk, spinal stenosis produces back pain that may be accompanied by sciatica, commonly affecting both legs. The pain may radiate to the toes and may progress to numbness or weakness unless the patient rests.Spondylolisthesis
A major structural disorder characterized by forward slippage of one vertebra onto another, spondylolisthesis may be asymptomatic or may cause low back pain, with or without nerve root involvement. Associated symptoms of nerve root involvement include paresthesia, buttock pain, and pain radiating down the leg. Palpation of the lumbar spine may reveal a “step-off” of the spinous process. Flexion of the spine may be limited.Transverse process fracture
This injury causes severe, localized back pain with muscle spasm and hematoma.Vertebral compression fracture
Initially, a vertebral compression fracture may be painless. Several weeks later, it causes back pain aggravated by weight bearing and local tenderness. Fracture of a thoracic vertebra may cause referred pain in the lumbar area.Vertebral osteomyelitis
Initially, vertebral osteomyelitis causes insidious back pain. As it progresses, the pain may become constant, more pronounced at night, and aggravated by spinal movement. Accompanying signs and symptoms include vertebral and hamstring spasms, tenderness of the spinous processes, fever, and malaise.Vertebral osteoporosis
Vertebral osteoporosis causes chronic, aching back pain that’s aggravated by activity and somewhat relieved by rest. Tenderness may also occur.Other causes
Neurologic tests
Lumbar puncture and myelography can produce transient back pain.Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Back pain:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abdominal aortic aneurysm (dissecting)
Life-threatening dissection of abdominal aortic aneurysm may initially cause low back pain or dull abdominal pain. More commonly, it produces constant upper abdominal pain. A pulsating abdominal mass may be palpated in the epigastrium; after rupture, though, it no longer pulses. Aneurysmal dissection can also cause mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock (such as cool, clammy skin) appear if blood loss is significant.
Ankylosing spondylitis
Ankylosing spondylitis is a chronic, progressive disorder that causes sacroiliac pain, which radiates up the spine and is aggravated by lateral pressure on the pelvis. The pain is usually most severe in the morning or after a period of inactivity and isn’t relieved by rest. Abnormal rigidity of the lumbar spine with forward flexion is also characteristic. This disorder can cause local tenderness, fatigue, fever, anorexia, weight loss, and occasional iritis.
Appendicitis
Appendicitis is a life-threatening disorder that causes a vague and dull discomfort in the epigastric or umbilical region, which migrates to McBurney’s point in the right lower quadrant. With retrocecal appendicitis, pain may also radiate to the back. The shift in pain is preceded by anorexia and nausea and is accompanied by fever, occasional vomiting, abdominal tenderness (especially over McBurney’s point), and rebound tenderness. Some patients also have painful, urgent urination.
Cholecystitis
Cholecystitis produces severe pain in the right upper quadrant of the abdomen that may radiate to the right shoulder, chest, or back. The pain may arise suddenly or may increase gradually over several hours, and patients usually have a history of similar pain after a high-fat meal. Accompanying signs and symptoms include anorexia, fever, nausea, vomiting, right-upper-quadrant tenderness, abdominal rigidity, pallor, and sweating.
Endometriosis
Endometriosis causes deep sacral pain and severe, cramping pain in the lower abdomen. The pain worsens just before or during menstruation and may be aggravated by defecation. It’s accompanied by constipation, abdominal tenderness, dysmenorrhea, and dyspareunia.
Intervertebral disk rupture
An intervertebral disk rupture produces gradual or sudden low back pain with or without leg pain (sciatica). It rarely produces leg pain alone. Pain usually begins in the back and radiates to the buttocks and leg. The pain is exacerbated by activity, coughing, and sneezing and is eased by rest. It’s accompanied by paresthesia (most commonly, numbness or tingling in the lower leg and foot), paravertebral muscle spasm, and decreased reflexes on the affected side. This disorder also affects posture and gait. The patient’s spine is slightly flexed and he leans toward the painful side. He walks slowly and rises from a sitting to a standing position with extreme difficulty.
Lumbosacral sprain
A lumbosacral sprain causes aching, localized pain and tenderness associated with muscle spasm on lateral motion. The recumbent patient typically flexes his knees and hips to help ease pain. Flexion of the spine intensifies pain, whereas rest helps relieve it. The pain worsens with movement and is relieved by rest.
Myeloma
Myeloma, a primary malignant tumor, causes back pain that usually begins abruptly and worsens with exercise. It may be accompanied by arthritic signs and symptoms, such as achiness, joint swelling, and tenderness. Other signs and symptoms include fever, malaise, peripheral paresthesia, and weight loss.
Pancreatitis (acute)
Acute pancreatitis is a life-threatening disorder that usually produces fulminating, continuous upper abdominal pain that may radiate to both flanks and to the back. To relieve this pain, the patient may bend forward, draw his knees to his chest, or move restlessly about.
Early associated signs and symptoms of acute pancreatitis include abdominal tenderness, nausea, vomiting, fever, pallor, tachycardia and, in some patients, abdominal guarding, rigidity, rebound tenderness, and hypoactive bowel sounds. A late sign may be jaundice. Occurring as inflammation subsides, Turner’s sign (ecchymosis of the abdomen or flank) or Cullen’s sign (bluish discoloration of skin around the umbilicus and in both flanks) signals hemorrhagic pancreatitis.
Perforated ulcer
In some patients, perforation of a duodenal or gastric ulcer causes sudden, prostrating epigastric pain that may radiate throughout the abdomen and to the back. This life-threatening disorder also causes boardlike abdominal rigidity, tenderness with guarding, generalized rebound tenderness, the absence of bowel sounds, and grunting, shallow respirations. Associated signs include fever, tachycardia, and hypotension.
Prostate cancer
Chronic aching back pain may be the only symptom of prostate cancer. This disorder may also produce hematuria, difficulty initiating a urine stream, dribbling, urine retention, unexplained cystitis as well as decrease in the urine stream. Signs and symptoms of prostate cancer may appear only in the advanced stages.
Pyelonephritis (acute)
Acute pyelonephritis produces progressive flank and lower abdominal pain accompanied by back pain or tenderness (especially over the costovertebral angle). Other signs and symptoms include high fever and chills, nausea and vomiting, flank and abdominal tenderness, and urinary frequency and urgency.
Reiter’s syndrome
In some patients, sacroiliac pain is the first sign of Reiter’s syndrome. Pain is accompanied by the classic triad of conjunctivitis, urethritis, and arthritis. In 30% of patients, skin lesions develop 4 to 6 weeks after onset of other symptoms and may last for several weeks.
Renal calculi
The colicky pain of renal calculi usually results from irritation of the ureteral lining, which increases the frequency and force of peristaltic contractions. The pain travels from the costovertebral angle to the flank, suprapubic region, and external genitalia. Its intensity varies but may become excruciating if calculi travel down a ureter. If calculi are in the renal pelvis and calyces, dull and constant flank pain may occur. Renal calculi also cause nausea, vomiting, urinary urgency (if a calculus lodges near the bladder), hematuria, and agitation due to pain. Pain resolves or significantly decreases after calculi move to the bladder. Encourage the patient to recover the calculi for analysis.
Sacroiliac strain
Sacroiliac strain causes sacroiliac pain that may radiate to the buttock, hip, and lateral aspect of the thigh. The pain is aggravated by weight bearing on the affected extremity and by abduction with resistance of the leg. Associated signs and symptoms include tenderness of the symphysis pubis and a limp or gluteus medius or abductor lurch.
Smallpox
Initial signs and symptoms of smallpox include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, and later the scab separates from the skin leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.
Spinal stenosis
Resembling a ruptured intervertebral disk, spinal stenosis produces back pain with or without sciatica, which commonly affects both legs. The pain may radiate to the toes and may progress to numbness or weakness unless the patient rests.
Transverse process and vertebral compression fractures
A transverse process fracture causes severe localized back pain with muscle spasm and hematoma. Initially, a vertebral compression fracture may be painless. Several weeks later, it causes back pain aggravated by weight bearing and local tenderness. Fracture of a thoracic vertebra may cause referred pain in the lumbar area.
Vertebral osteomyelitis
Initially, vertebral osteomyelitis causes insidious back pain. As it progresses, the pain may become constant, more pronounced at night, and aggravated by spinal movement. Accompanying signs and symptoms include vertebral and hamstring spasms, tenderness of the spinous processes, fever, and malaise.
Vertebral osteoporosis
Vertebral osteoporosis causes chronic, aching back pain that’s aggravated by activity and somewhat relieved by rest. Tenderness may also occur. Vertebral collapse, causing a backache with pain that radiates around the trunk, is the most common presenting feature of osteoporosis.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Back Pain:
Principal Causes of Back Pain
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Congenital
- Spineanomalies
- Developmental
- Scoliosis
- Scheuermann disease
- Trauma
- Musculoskeletal
- Herniated disc
- Spondylolysis
- Spondylolisthesis
- Slipped vertebral epiphysis
- Spinal epidural hematoma
- Infection/inflammation
- Discitis
- Disc space calcification
- Osteomyelitis
- Sacroiliac joint infection
- Juvenile rheumatoid arthritis
- Ankylosing spondylitis
- Spinal epidural abscess
- Sickle cell disease
- Neoplasm
- Vertebral tumors
- Intraspinal tumors
- Referred pain
- Psychogenic
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Back pain:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abdominal aortic aneurysm
(dissecting).Life-threatening dissection of this type of aneurysm may initially cause low back pain or dull abdominal pain. More commonly, it produces constant upper abdominal pain. A pulsating abdominal mass may be palpated in the epigastrium; after rupture, however, it no longer pulses. Aneurysmal dissection can also cause mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock (such as cool, clammy skin) appear if blood loss is significant.
Ankylosing spondylitis.Ankylosing spondylitis causes sacroiliac pain, which radiates up the spine and is aggravated by lateral pressure on the pelvis. The pain is usually most severe in the morning or after a period of inactivity and isn't relieved by rest. Abnormal rigidity of the lumbar spine with forward flexion is also characteristic. This disorder can cause local tenderness, fatigue, fever, anorexia, weight loss, and occasional iritis.
Appendicitis.Appendicitis is a life-threatening disorder in which a vague and dull discomfort in the epigastric or umbilical region migrates to McBurney's point in the right lower quadrant. With retrocecal appendicitis, pain may also radiate to the back. The shift in pain is preceded by anorexia and nausea and is accompanied by fever, occasional vomiting, abdominal tenderness (especially over McBurney's point), and rebound tenderness. Some patients also have painful, urgent urination.
Cholecystitis.Cholecystitis produces severe pain in the right upper quadrant of the abdomen that may radiate to the right shoulder, chest, or back. The pain may arise suddenly or may increase gradually over several hours, and patients usually have a history of similar pain after a high-fat meal. Accompanying signs and symptoms include anorexia, fever, nausea, vomiting, right upper quadrant tenderness, abdominal rigidity, pallor, and sweating.
Chordoma.A slow-developing malignant tumor, chordoma causes persistent pain in the lower back, sacrum, and coccyx. As the tumor expands, pain may be accompanied by constipation and bowel or bladder incontinence.
Endometriosis.Endometriosis causes deep sacral pain and severe, cramping pain in the lower abdomen. The pain worsens just before or during menstruation and may be aggravated by defecation. It's accompanied by constipation, abdominal tenderness, dysmenorrhea, and dyspareunia.
Intervertebral disk rupture.Intervertebral disk rupture produces gradual or sudden low back pain with or without leg pain (sciatica). It rarely produces leg pain alone. Pain usually begins in the back and radiates to the buttocks and leg. The pain is exacerbated by activity, coughing, and sneezing and is eased by rest. It's accompanied by paresthesia (most commonly, numbness or tingling in the lower leg and foot), paravertebral muscle spasm, and decreased reflexes on the affected side. This disorder also affects posture and gait. The patient's spine is slightly flexed and he leans toward the painful side. He walks slowly and rises from a sitting to a standing position with extreme difficulty.
Lumbosacral sprain.Lumbosacral sprain causes aching, localized pain and tenderness associated with muscle spasm on lateral motion. The recumbent patient typically flexes his knees and hips to help ease pain. Flexion of the spine intensifies pain, whereas rest helps relieve it. The pain worsens with movement and is relieved by rest.
Metastatic tumors.Metastatic tumors commonly spread to the spine, causing low back pain in at least 25% of patients. Typically, the pain begins abruptly, is accompanied by cramping muscular pain (usually worse at night), and isn't relieved by rest.
Myeloma.Back pain caused by myeloma, a primary malignant tumor, usually begins abruptly and worsens with exercise. It may be accompanied by arthritic signs and symptoms, such as achiness, joint swelling, and tenderness. Other signs and symptoms include fever, malaise, peripheral paresthesia, and weight loss.
Pancreatitis (acute).Pancreatitis is a life-threatening disorder that usually produces fulminating, continuous upper abdominal pain that may radiate to both flanks and to the back. To relieve this pain, the patient may bend forward, draw his knees to his chest, or move restlessly about.
Early associated signs and symptoms include abdominal tenderness, nausea, vomiting, fever, pallor, tachycardia and, in some patients, abdominal guarding, rigidity, rebound tenderness, and hypoactive bowel sounds. A late sign may be jaundice. Occurring as inflammation subsides, Turner's sign (ecchymosis of the abdomen or flank) or Cullen's sign (bluish discoloration of skin around the umbilicus and in both flanks) signals hemorrhagic pancreatitis.
Perforated ulcer.In some patients, perforation of a duodenal or gastric ulcer causes sudden, prostrating epigastric pain that may radiate throughout the abdomen and to the back. This life-threatening disorder also causes boardlike abdominal rigidity, tenderness with guarding, generalized rebound tenderness, the absence of bowel sounds, and grunting, shallow respirations. Associated signs include fever, tachycardia, and hypotension.
Prostate cancer.Chronic aching back pain may be the only symptom of prostate cancer. This disorder may also produce hematuria and decrease the urine stream.
Pyelonephritis (acute).Pyelonephritis produces progressive flank and lower abdominal pain accompanied by back pain or tenderness (especially over the costovertebral angle). Other signs and symptoms include high fever and chills, nausea and vomiting, flank and abdominal tenderness, and urinary frequency and urgency.
Renal calculi.The colicky pain of renal calculi usually results from irritation of the ureteral lining, which increases the frequency and force of peristaltic contractions. The pain travels from the costovertebral angle to the flank, suprapubic region, and external genitalia. Its intensity varies but may become excruciating if calculi travel down a ureter. If calculi are in the renal pelvis and calyces, dull and constant flank pain may occur. Renal calculi also cause nausea, vomiting, urinary urgency (if a calculus lodges near the bladder), hematuria, and agitation due to pain. Pain resolves or significantly decreases after calculi move to the bladder. Encourage the patient to recover the calculi for analysis.
Rift Valley fever.Rift Valley fever may present as several different clinical syndromes. Typical signs and symptoms include fever, myalgia, weakness, dizziness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.
Sacroiliac strain.Sacroiliac strain causes sacroiliac pain that may radiate to the buttock, hip, and lateral aspect of the thigh. The pain is aggravated by weight bearing on the affected extremity and by abduction with resistance of the leg. Associated signs and symptoms include tenderness of the symphysis pubis and a limp or gluteus medius or abductor lurch.
Smallpox (variola major).Initial signs and symptoms of smallpox include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and then spreads to the trunk and legs. Within 2 days the rash becomes vesicular and later pustular. The lesions develop at the same time, appear identical, and are more prominent on the face and extremities. The pustules are round, firm, and deeply embedded in the skin. After 8 to 9 days, the pustules form a crust, and later the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.
Spinal neoplasm (benign).Spinal neoplasm typically causes severe, localized back pain and scoliosis.
Spinal stenosis.Resembling a ruptured intervertebral disk, spinal stenosis produces back pain with or without sciatica, which commonly affects both legs. The pain may radiate to the toes and may progress to numbness or weakness unless the patient rests.
Spondylolisthesis.A major structural disorder characterized by forward slippage of one vertebra onto another, spondylolisthesis may be asymptomatic or may cause low back pain, with or without nerve root involvement. Associated symptoms of nerve root involvement include paresthesia, buttock pain, and pain radiating down the leg. Palpation of the lumbar spine may reveal a “step-off” of the spinous process. Flexion of the spine may be limited.
Transverse process fracture.Transverse process fracture causes severe localized back pain with muscle spasm and hematoma.
Vertebral compression fracture.Initially, vertebral compression fracture may be painless. Several weeks later, it causes back pain aggravated by weight bearing and local tenderness. Fracture of a thoracic vertebra may cause referred pain in the lumbar area.
Vertebral osteomyelitis.Initially, vertebral osteomyelitis causes insidious back pain. As it progresses, the pain may become constant, more pronounced at night, and aggravated by spinal movement. Accompanying signs and symptoms include vertebral and hamstring spasms, tenderness of the spinous processes, fever, and malaise.
Vertebral osteoporosis.Vertebral osteoporosis causes chronic, aching back pain that is aggravated by activity and somewhat relieved by rest. Tenderness may also occur.
Other causes
Neurologic tests.Lumbar puncture and myelography can produce transient back pain.
Source: Nursing: Interpreting Signs and Symptoms, 2007
Learning Problems:
Learning Problems - etiology
(The 5-Minute Pediatric Consult)
Speculative etiologies (widely discussed but essentially unproven):
- Food allergies
- “Developmental optometric” disorders
- Exposure to food preservatives or sugar
Source: The 5-Minute Pediatric Consult, 2008
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