There is an extensive list of differentials in your hand-out, and I am not going to go through all of those, since that’s pretty detailed, but when you see someone with back pain, I think it’s an important aspect of mental discipline. Just to run through a differential and think about some of these things; tumor in particular. An individual over the age of 45, remember that about 10% of patient’s with an unknown primary, will present with back pain as the first symptom of their tumor due to metastatic disease, so it’s probably a good idea, in somebody over the age of 45 coming to you with back pain for the first time, to at least get an x-ray to make sure there is not a lytic lesion there, because that is something you don’t want to miss.
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Of course trauma, infection, very difficult diagnosis to make, and I will finish the talk on that. You really have to think of that, that is a very subtle diagnosis. Mechanical by far, in a way, the most common, and then some of the relatively uncommon entities.
Physical examination. I would just like to run through a few things; the components of that are obviously, you watch the patient’s gait, you check range of motion, you palpate and then do a neurological examination. One of the classic differentials is the hip/spine is actually very, very simple. Flavored kamagra online at discount canadian pharmacy. You don’t even have to read all these areas of referral, posterior, superior, iliac spine or sacroiliac joint, that may be related to the L5 root, and these are basic points of physical examination, buttocks for S1, anterior thigh for L3-4, posterior for L5, calf and foot for L5-S1. It’s a pretty simple differential. Hip is groin pain. Not pain going to the buttock not pain going to the greater trochanter, not pain going to the sacroiliac joint, if you have a bad hip you’re going to have groin pain. Everything else you should think comes from the spine until proven otherwise.
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