Diagnostic Tests for Back pain

Diagnostic Test list for Back pain:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Back pain includes:

• Physical examination
  • General inspection - posture, gait, level of distress.
  • Inspect the back, examine range of movement of the back to reproduce pain, palpation of the back
  • Neurological examination of the lower limbs if symptoms extend below the buttocks
  • Examine related joints e.g. hip and sacroiliac
  • General medical examination if appropriate e.g. rectal examination
• Blood tests
  • Full blood count and ESR
  • Calcium, Phosphate and Alkaline phosphatase
  • Prostatic specific antigen (PSA) in males if appropriate
  • HLA-B27 antigen test fro Ankylosing Spondylitis and Reiter's disease
  • Rheumatoid factor for Rheumatoid arthritis
  • Serum electrophoresis for Multiple myeloma
  • Blood culture for vertebral osteomyelitis
• Other tests
  • Mantoux test - if suspect Skeletal tuberculosis.
  • Urine tests - Urinalysis and culture to detect Urinary tract infection.
  • Spinal X-ray - can detect arthritis changes, fractures, reduced bone mass, reduced bone height, spondylolisthesis.
  • Spinal CT or MRI - perform if radiation of pain around the trunk or into legs or if the person has persistent back pain as can detect spinal canal stenosis or nerve root compression.
  • Bone scan - can detect the early development of malignant disease, osteomyelitis and inflammatory disease before changes are apparent on plain X-Ray.
  • Bone densitometry - can predict an increased risk of osteoporosis.
  • Electromyographic (EMG) studies - to screen leg pain and differentiate neurological diseases from nerve compression syndromes.
  • If the above investigations are negative, the possibility of a non- neurological or non-orthopedic condition causing the back pain should be considered e.g. abdominal ultrasound scan to rule out aortic aneurysm; pelvic tumor ; Prostatic tumor , pancreatic tumor

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