Spinal Masqueraders
Original Editor - Rachael Lowe
Top Contributors - Admin, Kim Jackson, Simisola Ajeyalemi, Jess Bell, Mariam Hashem and WikiSysop
Introduction[edit | edit source]
Spinal masqueraders are conditions which present as lower back pain but are actually caused by non-mechanical referred pain from a visceral structure. Patients will present with lower back pain but the source is not a mechanical structure[1]. Although the percentage of patients seen by Physiotherapists with these conditions is small it is important to be able to recognise the red flags that could point towards these conditions.
Sources of Visceral Pain[edit | edit source]
Some of the sources of visceral pain include:
- Inflammation - eg. Appendicitis
- Distention - eg. Bowel Obstruction
- Ischemia - eg. a tumour blocking blood supply
The blood supply to internal organs is in close proximity to the sympathetic nerve system so changes to the blood supply from ischemia, distention of inflammation can directly affect the nerve innervation.
Referral Patterns for visceral pathologies[edit | edit source]
This diagram depicts the most common referral patterns for visceral pathologies.
Clinical presentations[edit | edit source]
Klineberg et al[2] summarised examples of medical causes of back pain, and the symptoms often associated with them:
Aortic Aneurysm |
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Myocardial Infarction |
Typical symptoms being:
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Ectopic Pregnancy | Classic triad of symptoms:
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Acute Pancreatitis |
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Duodenal Ulcers |
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Urinary Tract Infections |
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Prostatitis |
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Gallstones |
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Kidney Stones |
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Visceral Cancer |
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References[edit | edit source]
- ↑ Walcott B, Coumans J, Kahle K. Diagnostic pitfalls in spine surgery: masqueraders of surgical spine disease. Neurosurgical Focus. 2011;31(4).
- ↑ Klineberg E, Mazanec D, Orr D, Demicco R, Bell G, McLain R. Masquerade: medical causes of back pain. Cleveland Clinic journal of medicine 2007;74(12):905-13.