UMEM Educational Pearls

Category: Orthopedics

Title: Back Pain

Posted: 7/24/2010 by Brian Corwell, MD (Updated: 3/29/2024)
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  • Back pain is the most common musculoskeletal complaint that results in visits to the ED.
  • It has a benign course in more than 90% of patients, so we must be vigilant and comfortable looking for warning signs of a neurologically impairing or life-threatening cause.
  • We rely on the presence of so-called "red flags" or alarm symptoms to guide further diagnostic tests, specialty evaluation, and treatment. 
  • Additionally, always consider 2 important extra-spinal causes of back pain: aortic dissection (sudden onset back pain) and abdominal aortic aneurysm (patients >50, esp. those who you think have a kidney stone- isolated back and groin pain is a common presentation).

 

History and Physical Examination Red Flags

Historical Red Flags Physcial Red Flags
Age under 18 or over 50
Pain lasting more than 6 weeks
History of cancer
Fever and chills
Night sweats, unexplained weight loss
Recent bacterial infection
Unremitting pain despite rest and analgesics
Night pain
Intravenous drug users, immunocompromised
Major trauma
Minor trauma in the elder
Fever
Writhing in pain
Bowel or bladder incontinence
Saddle anesthesia
Decreased or absent anal sphincter tone
erianal or perineal sensory loss
Severe or progressive neurologic defect
Major motor weakness