Spinal Masqueraders: Difference between revisions
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'''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]] | |||
== Introduction == | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
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== Introduction == | |||
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<ref name="Walcott">Walcott B, Coumans J, Kahle K. Diagnostic pitfalls in spine surgery: masqueraders of surgical spine disease. Neurosurgical Focus. 2011;31(4).</ref>. 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. | 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<ref name="Walcott">Walcott B, Coumans J, Kahle K. Diagnostic pitfalls in spine surgery: masqueraders of surgical spine disease. Neurosurgical Focus. 2011;31(4).</ref>. 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== | == Sources of Visceral Pain == | ||
Some of the sources of visceral pain include: | Some of the sources of visceral pain include: | ||
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*Ischemia - eg. a tumour blocking blood supply | *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 | 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 == | == Referral Patterns for visceral pathologies == | ||
This diagram depicts the most common referral patterns for visceral pathologies. | This diagram depicts the most common referral patterns for visceral pathologies. | ||
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[[Image:Visceral pain referral.jpg|427x300px]] | [[Image:Visceral pain referral.jpg|427x300px]] | ||
Klineberg et al ( | == Clinical presentations == | ||
Klineberg et al<ref>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.</ref> summarised examples of medical causes of back pain, and the symptoms often associated with them: | |||
{| width="80%" border="1" cellpadding="1" cellspacing="1" | {| width="80%" border="1" cellpadding="1" cellspacing="1" | ||
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*Pain can radiate to the anterior chest. | *Pain can radiate to the anterior chest. | ||
*Rest does not relieve it. | *Rest does not relieve it. | ||
*Palpation over the back and changes in position do not aggravate the pain. Palpation of the abdomen may increase pain. | *Palpation over the back and changes in position do not aggravate the pain. Palpation of the abdomen may increase pain. | ||
*Loss of lower extremity pulses may occur as the dissection progresses. | *Loss of lower extremity pulses may occur as the dissection progresses. | ||
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| Myocardial Infarction | | Myocardial Infarction | ||
| | | | ||
*Back pain is usually mid thoracic and may radiate to the arm or axilla. | *Back pain is usually mid thoracic and may radiate to the arm or axilla. | ||
*Pain may be unaffected by posture or changes in position. | *Pain may be unaffected by posture or changes in position. | ||
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|- | |- | ||
| Ectopic Pregnancy | | Ectopic Pregnancy | ||
| Classic triad of symptoms: <br> | | Classic triad of symptoms: <br> | ||
*Missed menstrual period | *Missed menstrual period | ||
*Vaginal bleeding | *Vaginal bleeding | ||
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| | | | ||
*Pain is often across the back and radiates to the groin. | *Pain is often across the back and radiates to the groin. | ||
*Patients often report dysuria, urgency and frequency. | *Patients often report dysuria, urgency and frequency. | ||
*If the infection affects the renal system the pain is often more severe and can radiate to the upper back. | *If the infection affects the renal system the pain is often more severe and can radiate to the upper back. | ||
*Fever may also be present. | *Fever may also be present. | ||
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| Kidney Stones | | Kidney Stones | ||
| | | | ||
*Common in middle aged men and women. | *Common in middle aged men and women. | ||
* | *Interruption of urine flow results in severe pain that may radiate from the thoracolumbar region around to the lower abdomen and groin. | ||
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== References == | |||
<references /> | |||
[[Category:Lumbar Spine]] |
Latest revision as of 11:30, 28 August 2023
Original Editor - Rachael Lowe
Top Contributors - Admin, Kim Jackson, Simisola Ajeyalemi, Mariam Hashem, WikiSysop and Jess Bell
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.