Non-Neuromusculoskletal Sources of Neck and back pain Flashcards
What are some common serious spinal pathologies and their incidence
- 4% compression fractures that typically occur in >50 years old
- 3% spondylolysis <20
- malignant neoplasm is most common systemic disease effecting the spine (1% of patients with LBP)
What cancers typically cause spinal metastases
- breast
- lung
- prostate
Cancer and LBP red flags
- unexplained weight loss
- pain >1 month (doesn’t go along with phases of healing)
- failure to improve with conservative therapy
- pain that is not relieved with recumbency
How can cancer cause pain
- tumor creates pressure on pain sensitive structures
- tumor causes obstruction of host tissue’s blood supply
- tumor causes obstruction of host organ function
- tumor causes tissue destruction due to pressure necrosis/ulceration
How do visceral structures refer symptoms
- embryologic development
- multisegmental innervation
- direct pressure/shared pathways
Embryologic development as a referred symptoms theory
- pain is referred to site where organ was located in fetal development
- where the tissue developed
Multisegmental innervation
- major visceral organs are innervated by afferent fibers from multiple spinal levels
- shared innervation
Direct pressure and shared pathways as a symptom referral
- organs impinging the respiratory diaphragm can refer pain
- C3-C5 is diaphragm innervation and can cause symptoms elsewhere
Potential sources of neck and back symptoms
- lung
- liver
- heart
- esophagus
- stomach
- kidney
- gall bladder
- pancreas
- GI tract
- uterus
- spleen
- aorta
- diaphragm
- bladder
- ureter
- prostate
Neck symptoms can refer from
- lung
- liver
- heart (usually left side)
- esophagus
Thoracic and rib pain can refer from what structures
- heart
- lung
- stomach
- kidney
- gall bladder
- pancreas
- esophagus
lumbar pain can refer from
- GI
- bladder
- ureter
- uterus
- kidney
- aortic aneurysm
Shoulder pain can refer from
- heart
- lung
- gall bladder
- spleen
- pancreas
- diaphragm
- esophagus
- liver
- kidney
- aortic aneurysm
Buttock, hip and thigh pain can refer from
- GI
- uterus
- prostate
- kidney
History of symptoms to figure out if is mechanical or medical
- is there a hx of mechanical injury
- is the cause unknown
- can occupation, recreational interest or hobbies explain symptoms
- do past illnesses, injuries, and or surgeries provide insight
- looking for mechanical causes, if not found need to consider other potential sources
mechanical onset of symptoms
- sudden with mechanical event
- gradual from cumulative trauma
Systemic onset of symptoms
- slowly without mechanical event
- could be cancer growing
Vascular onset of symptoms
- sudden and sharp without mechanical event
Frequency of mechanical symptoms
- intermittent
- most MSK pain relieved or diminished with certain positions that will remove stress
- constant pain = systemic as often no influence with positional changes
Red flags for back pain
- age less than 20 or > 50
- previous history of cancer
- consitutional symptoms
- recent urinary tract infection
- history of injection drug use
- immunocompromised condition
- failure to improve with conservative care
- pain not relieved by recumbency
- severe constant night pain
- progressive neurological deficit
- saddle anesthesia
- back pain with abdominal, pelvic or hip pain
- Hx of falls or trauma
- significant morning stiffness in all spinal motions
- skin rash
not to memorize but look over
Viscerogenic causes of neck and back pain?
- cancer
- cardiovascular
- pulmonary
- Renal/urologic
- Gastrointestinal
- gynecologic
Cervical Cancer
What types of cancer
- Metastatic Lesion
- Cervical Bone tumors
- cervical cord tumors
- lung cancer; pancoast tumor
- esophageal cancer
- thyroid cancer
Cancer: Thoracic
- mediastinal tumors
- metastatic extension
- pancreatic cancer
- breast cancer
Lumbar Cancer
- metastatic lesion
- prostate cancer
- testitular cancer
- pancreatic cancer
- colorectal cancer
- multiple myeloma
- lymphoma
Cardiopulmonary: symptoms in the cervical/thoracic
- angina
- myocardial infarction
- aortic aneurysm
Cardiopulmonary: lumbar symptoms
- abdominal aortic aneurysm
- endocarditis
- myocarditis
- peripheral vascular: post-op bleeding from anterior spine surgery
Pulmonary: cervical symptoms
can be caused by
- lung cancer; pancoast tumor
- tracheobronchial irritation
- chronic bronchitis
- pneumothorax
Pulmonary conditions that can refer to thoracic symptoms
- respiratory or lung infection
- emphysema
- chronic bronchitis
- pleurisy
- pneumothorax
- pneumonia
Renal/urologic: thoracic
- acute pyelonephritis
- kidney disease
Renal/urologic: lumbar
- kidney disorders:
- acute pyelonephritis
- perinephritic abcess
- nephrolithiasis
- ureteral colic
- UTI
- dialysis
- renal tumors
Gastrointestinal in cervical region
- esophagitis
- esophageal cancer
GI: thoracic region
conditions
- esophagitis
- esophageal spasm
- peptic ulcer
- acute cholescystitis
- biliary colic
- pancreatic disease
GI: lumbar
conditions that could refer to this area
- small intestin: obstruction, irritable bowel syndrome, crohn’s disease
- colon: diverticular disease
- pancreatic disease
- appendicitis
Gynecologic: lumbar
- cancer
- retroversion of uterus
- uterine fibroids
- ovarian cysts
- endometriosis
- pelvic inflammatory disease
Gynecologic lumbar
- incest/sexual assult
- rectocele, cystocele
- uterine prolaspe
- normal pregnancy
- multiparity
Other things that can refer to the spine
- infection: vertebral osteomyelitis, meningitis, herpes zoster, HIV, lyme disease
- osteoporosis
- fibromyalgia
- psychogenic
- fracture
