Thoracic Back Pain Red Flags: Difference between revisions
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== Introduction == | == Introduction == | ||
[[File:Piron-guillaume-y5hQCIn1c6o-unsplash.jpg|right|frameless]] | |||
Thoracic back pain is more likely than neck or low back pain to be caused by serious underlying pathology. | Thoracic back pain is more likely than neck or low back pain to be caused by serious underlying pathology. | ||
* Thoracic spine pain and visceral pain can mimic the other due to the shared afferent innervation of the ANS sympathetics, which originate from T1-L2 afferents from the spinal cord.<ref>Benhamou CL, Roux C, Tourliere D, Gervais T, Viala JF, Amor B. Pseudovisceral pain referred from costovertebral arthropathies. Twenty-eight cases. Spine (Phila Pa 1976) 1993 May;18(6):790-795</ref> | |||
* Segments T4-T7 have the potential to cause pseudoanginal pain as well as symptoms generated by a cough, sneeze, deep breath, movement of the trunk, palpation, and compression<ref>Hamberg J, Lindahl O. Angina pectoris symptoms caused by thoracic spine disorders. Clinical examination and treatment. Acta Med Scand Suppl 1981;644:84-86</ref> (Heart surgery, image on R) | |||
* However, many patients with thoracic back pain have a benign, mechanical cause. | |||
== [[The Flag System|Red flags]] for possible serious spinal pathology == | |||
== Red flags for possible serious spinal pathology == | |||
Include<ref>Patient Thoracic [https://patient.info/doctor/thoracic-back-pain Back Pain] Available from: https://patient.info/doctor/thoracic-back-pain (last accessed 16.5.2020)</ref> | Include<ref>Patient Thoracic [https://patient.info/doctor/thoracic-back-pain Back Pain] Available from: https://patient.info/doctor/thoracic-back-pain (last accessed 16.5.2020)</ref> | ||
* Recent violent trauma (such as a vehicle accident or fall from a height). | * Recent violent trauma (such as a vehicle accident or fall from a height). | ||
* Minor trauma, or even just strenuous lifting, in people with osteoporosis. | * Minor trauma, or even just strenuous lifting, in people with osteoporosis. | ||
* Age at onset less than 20 or over 50 years (new back pain). | * Age at onset less than 20 or over 50 years (new back pain). | ||
* History of cancer, drug abuse, HIV, immunosuppression or prolonged use of corticosteroids. | *[[File:National-cancer-institute-0YBIMOqQzt0-unsplash.jpg|right|frameless]]History of cancer, drug abuse, HIV, immunosuppression or prolonged use of corticosteroids. | ||
* Constitutional symptoms - eg, fever, chills, unexplained weight loss. | * Constitutional symptoms - eg, fever, chills, unexplained weight loss. | ||
* Recent bacterial infection. | * Recent bacterial infection. | ||
* Pain that is: | * Pain that is: | ||
* Constant, severe and progressive | * Constant, severe and progressive; Non-mechanical without relief from bed rest or postural modification; Unchanged despite treatment for 2-4 weeks; Accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis). | ||
* Structural deformity. | * Structural deformity. | ||
* Severe or progressive neurological deficit in the lower extremities. | * Severe or progressive neurological deficit in the lower extremities. | ||
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[[Category:Thoracic Spine - Conditions]] | |||
[[Category:Thoracic Spine]] |
Revision as of 08:21, 16 May 2020
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Introduction[edit | edit source]
Thoracic back pain is more likely than neck or low back pain to be caused by serious underlying pathology.
- Thoracic spine pain and visceral pain can mimic the other due to the shared afferent innervation of the ANS sympathetics, which originate from T1-L2 afferents from the spinal cord.[1]
- Segments T4-T7 have the potential to cause pseudoanginal pain as well as symptoms generated by a cough, sneeze, deep breath, movement of the trunk, palpation, and compression[2] (Heart surgery, image on R)
- However, many patients with thoracic back pain have a benign, mechanical cause.
Red flags for possible serious spinal pathology[edit | edit source]
Include[3]
- Recent violent trauma (such as a vehicle accident or fall from a height).
- Minor trauma, or even just strenuous lifting, in people with osteoporosis.
- Age at onset less than 20 or over 50 years (new back pain).
- History of cancer, drug abuse, HIV, immunosuppression or prolonged use of corticosteroids.
- Constitutional symptoms - eg, fever, chills, unexplained weight loss.
- Recent bacterial infection.
- Pain that is:
- Constant, severe and progressive; Non-mechanical without relief from bed rest or postural modification; Unchanged despite treatment for 2-4 weeks; Accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis).
- Structural deformity.
- Severe or progressive neurological deficit in the lower extremities.
Other Potential Red Flags associated with thoracic spine pain[edit | edit source]
Listed in the following charts:
Cardiac Ischemia | Dissecting thoracic aneurysm | Peptic Ulcer | Cholecystitis | Renal Infection and Kidney Stones |
- History of risk factors for CAD, MI
- Angina - Nausea |
- Sudden, severe and unrelenting chest pain that can radiate to the upper back.
- Unrelieved with laying down. |
- Boring pain from epigastric area to middle thoracic spine. Triggered or relived with meals.
- History of NSAID use. - Perforated ulcer can refer pain to shoulder with irritation of the diaphragm. |
- Right upper quadrant and scapular pain. Fever, nausea and vomiting. 1-2 hours after a fatty meal. | - Renal colic/flank pain.
- Fever, nausea, and vomiting. - Increased risk for kidney infection with ongoing UTI. |
Fracture | Neoplastic Conditions | Inflammatory Disorders | Inflammatory or Systemic Disease |
- Traumatic: blunt trauma or injury.
- Compression Fractures: Caucasian race, history of smoking, early menopause, thin body build, sedentary lifestyle, steroid treatment, and excessive consumption of caffeine or alcohol. - Acute thoracic pain from trivial strain or trauma in males or females > 60 years. |
- Age over 50 years.
- Previous history of cancer. - Unexplained weight loss. - Constant pain, no relief with bed rest. - Night pain. |
- Ankylosing Spondylitis:limited chest expansion, less <2.5 cm measured at nipple line.
- Sacroilitis. - Morning pain and stiffness. - Peripheral joint involvemnt. - HLA-B27 |
- Temperature > 100°
- Blood Pressure >160/95mmHg - Resting Pulse > 100 bpm. - Resting Respiration > 25 bpm. - Fatigue. - Osteomyelitis, diskitis, epidural infection, pericarditis. |
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ Benhamou CL, Roux C, Tourliere D, Gervais T, Viala JF, Amor B. Pseudovisceral pain referred from costovertebral arthropathies. Twenty-eight cases. Spine (Phila Pa 1976) 1993 May;18(6):790-795
- ↑ Hamberg J, Lindahl O. Angina pectoris symptoms caused by thoracic spine disorders. Clinical examination and treatment. Acta Med Scand Suppl 1981;644:84-86
- ↑ Patient Thoracic Back Pain Available from: https://patient.info/doctor/thoracic-back-pain (last accessed 16.5.2020)