Diagnostic Tests for Lower back pain

Diagnostic Test list for Lower back pain:

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

• General inspection
  • Posture, gait, level of distress
• Physical examination
  • Inspect the lower back, examine range of movement of the back to reproduce pain, palpation of the back
  • Neurological examination of the lower limbs
  • Examine hip and sacro-iliac joints
  • 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
• Mantoux test - if suspect Skeletal tuberculosis.
• Urine tests
  • Urinalysis and culture to detect Urinary tract infection
• Radiological investigations
  • X-Ray of Lumbosacral spinal - can detect arthritis changes, fractures, reduced bone mass, reduced bone height, spondylolisthesis.
  • CT or MRI of lumbosacral spine - perform if radiation of pain into trunk or legs or if the person has persistent back pain. 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

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