Lower Back Rib Pain
Pain in the back ribs can happen for many reasons. It can result from an injury, such as muscle strain or fractured rib, but it can also be a sign of a more serious condition, such as osteoporosis, gallstones, or a lung condition. The pain may be sharp or dull and mild or severe.
Often, the pain resolves without intervention, but it can sometimes indicate a more serious medical condition that requires specialist care. This is more likely if the pain is intense or there are other symptoms. This article looks at some common causes of pain in the back of the ribs, as well as the associated symptoms and typical treatments.
Injuries can cause back rib pain. Common rib-related injuries include:
bruised ribspulled muscles fractures broken ribs
If pain after an injury is lasting or severe, the cause may be a broken rib. To diagnose this injury, a doctor may use an X-ray or MRI, Treatment options vary. Many people with broken ribs just need rest and pain relief medication. Surgical intervention is sometimes necessary, but only in severe cases.
sharp, severe pain in the upper back or ribsstiffness and tension in the upper back musclesspasms in the intercostal muscles
To treat this type of strain, doctors often recommend pain medication and physical therapy, Costochondritis is inflammation of the cartilage that holds the ribs together. It is a common condition, particularly in adults aged 40–50, and it causes pain in the chest wall, sometimes at the back of the ribs.
heat therapylocal or oral pain medicationscapsaicin creamphysical therapy
For many people with costochondritis, the issue improves in a few weeks, However, because the symptoms can be similar to those of a heart condition, it is vital to speak with a doctor. Preexisting conditions, such as osteoporosis, can weaken the ribs so that they break more easily, often during less intensive activities.
Osteoporosis causes the bones to lose the minerals that they need to stay strong. With a low mineral density, bones can fracture spontaneously or when the person is coughing. It is a common condition in older adults, especially in females. The Centers for Disease Control and Prevention (CDC) report that 12.6% of adults over 50 had osteoporosis in 2017–2018.
The figure for females only was 19.6%. The symptoms of osteoporosis include soreness and pain. Healthcare professionals often diagnose the issue with X-rays. They may also test a person’s kidney and thyroid function. Some treatment options for osteoporosis include:
doing gentle strength trainingreducing alcohol consumption and cigarette smoking, if applicabletaking calcium and vitamin D3 supplementstaking medications that reduce the risk of fractures
Fibromyalgia causes widespread pain in the muscles and bones. People may also have specific tender points. Researchers are unsure what causes it, but it is more common in females than in males. Beyond the pain, fibromyalgia often occurs with:
fatigue headaches paresthesia, which is a numb or burning sensation, usually in the extremities depression anxiety cognitive disturbances, such as problems processing and remembering information
Because fibromyalgia has such diverse symptoms, doctors may recommend a variety of interventions, including:
improving sleep quality practicing relaxation techniquesstarting cognitive behavioral therapy getting regular cardiovascular exercisetaking medications, including antidepressants and anticonvulsants
Gallstones are hardened deposits in the gallbladder, They sometimes cause no symptoms, but they can also move and block the ducts of the gallbladder, leading to problems. Gallstones can cause pain, especially when they block ducts. The classic presentation is pain in the upper right part of the stomach, under or around the ribs.
Some people also feel the pain in their back, such as between their shoulder blades. The pain may be intense, though it is mild for some people. It usually develops shortly after a meal and lasts for a few hours, A person may also have nausea and vomiting or jaundice, This yellowing of the eyes and skin signals that the gallstones are affecting the liver.
It may also cause dark urine. A blocked gallbladder duct can become a medical emergency. Anyone with gallstones should receive prompt medical attention for any intense abdominal pain, especially if there is jaundice. A pulmonary embolism occurs when a blood vessel in a lung is blocked, often by a blood clot.
A person may initially notice pain and swelling in one leg when the clot blocks a blood vessel there. If the clot breaks loose, it can travel to the lungs. Pulmonary embolisms are serious and relatively common. Research shows that they are responsible for around 100,000 deaths per year in the United States, and this figure is rising.
Aside from pain in the back of the ribs, a pulmonary embolism can cause the following symptoms:
coughing, which may bring up blood sweatingheadaches and lightheadednessshortness of breathrapid breathinganxietyan irregular heartbeat
A pulmonary embolism is a life threatening emergency that requires immediate treatment. Typically, treatment involves blood thinning medication, which makes it harder for clots to form. A person who cannot tolerate this approach receives a different medication that prevents the blood from clotting.
Certain health conditions that affect the lungs can also cause back rib pain. For example, pleurisy, or inflammation of the lining of the lungs, can cause pain in the chest, shoulders, and back ribs. Researchers know that several underlying issues can cause pleurisy. For this reason, the treatments are varied.
Lung cancer can also cause pain in the chest and ribs. It is life threatening and a leading cause of cancer-related death in the U.S. Other symptoms of lung cancer include coughing, which may bring up blood, and shortness of breath. The best course of treatment depends on the cancer’s type and stage, as well as factors specific to each individual.
The pain worsens.It remains after a few days of home treatment.It limits the ability to move.It occurs with a fever, chills, vomiting, nausea, or other symptoms.
People who think that they may have gallstones should call a healthcare professional and ask if their symptoms are signs of an emergency. But anyone with intense gallstone pain should go to an emergency room. In general, seek emergency treatment if:
The pain is so severe that it limits the ability to function.It occurs with jaundice.It occurs with trouble breathing, shortness of breath, or chest pain.The person feels very sick.Any symptoms rapidly worsen over several hours.
Minor injuries can cause pain in the back ribs. These injuries are not usually dangerous, and they often heal on their own. However, this pain can also stem from a more serious health condition. This is especially likely if the pain is very intense, comes on suddenly, with no clear cause, or occurs with other symptoms.
- 1 Why is thoracic back pain a red flag?
- 2 Can bad posture cause rib pain?
- 3 What causes pain under right back rib cage?
- 4 What is the T4 syndrome?
When should I be concerned about lower rib pain?
3. Pleurisy – Lining the inside of your chest cavity and the outside of your lungs are two layers of tissue called ; the area between these layers is called the pleural space. The layers generally glide against each other smoothly as you inhale and exhale.
With pleurisy, the layers become inflamed due to a viral infection, or other medical condition and rub together roughly, causing pain every time you breathe or cough. Fluid may also collect in the pleural space, causing shortness of breath. Telltale sign : Doctors can actually hear the membranes rubbing together, called a friction rub, when they listen to your chest with a stethoscope.
Based on your symptoms, your doctor may order imaging or blood tests to help determine the underlying cause of the pleurisy and to see if fluid has built up. If it has, the fluid may need to be drained. If the fluid is a result of a bacterial infection, you’ll be given antibiotics.
If it’s from a virus, it may have to run its course, but over-the-counter pain relievers may help to reduce your symptoms. With any rib cage pain, if you can’t breathe, your skin turns blue or you have severe chest pain, call 911 or go to the emergency room right away. Our family medicine doctors deliver high-quality health care for every stage of your life.
We offer vaccinations, perform screening exams, manage your chronic medical issues, treat injuries and more. Topics : 3 Reasons You Might Have Rib Cage Pain
Why is thoracic back pain a red flag?
Thoracic Back Pain (Causes, Symptoms, and Treatment) Thoracic back pain is common throughout life but is not as well studied as neck pain or low back pain. Thoracic back pain is more often due to serious spinal pathology than neck or low back pain but thoracic back pain is also prevalent among healthy individuals without any serious underlying cause.
- For further information on causes, differential diagnosis and management of back pain, see the separate and articles.
- A review found the range of prevalence estimates of thoracic back pain in the general population to be very broad because of many factors, including the different definitions and duration of thoracic back pain included.
The results of the review were as follows:
- Prevalence data ranged from 4.0-72.0% (at any one time), 0.5-51.4% (seven-day), 1.4-34.8% (one-month), 4.8-7.0% (three-month), 3.5-34.8% (one-year) and 15.6-19.5% (lifetime).
- Studies reported a higher prevalence for thoracic back pain in children and adolescents, especially for females.
- In children and adolescents, thoracic back pain was associated with female gender, postural changes associated with backpack use, backpack weight, other musculoskeletal symptoms, participation in specific sports, chair height at school and difficulty with homework. Poorer mental health and age transition from early to late adolescence were also significant risk factors.
- In adults, thoracic back pain was associated with concurrent other musculoskeletal symptoms and difficulty in performing activities of daily living.
- Thoracic back pain can occur as a result of trauma or sudden injury, or it can occur through strain or poor posture over time.
- Always consider the possibility of, especially in older patients.
- The most common cause of thoracic back pain appears to originate from muscular irritation or other soft tissue problems. These can arise from lack of strength, poor posture, prolonged sitting at a computer, using a backpack, overuse injuries (such as repetitive motion), or trauma (such as a whiplash injury caused by a car accident or as a result of a sports injury).
- A study of cadavers suggests an association between cervical spine stenosis and thoracic spine stenosis.
- Asymptomatic thoracic disc herniations are relatively common but symptomatic disc herniations are rare. They occur in approximately 5 in 1,000 disc herniations presenting in a clinical setting.
- The thoracic spine is a relatively common site for inflammatory, degenerative, metabolic, infective and neoplastic conditions.
- Thoracic back pain and dysfunction are associated with conditions such as primary and secondary osteoporosis (especially vertebral fractures and hyperkyphosis arising from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann’s disease.
The presentation of thoracic back pain will depend on the underlying cause. Thoracic back pain is more likely than neck or low back pain to be caused by serious underlying pathology. However, many patients with thoracic back pain have a benign, mechanical cause. Red flags for possible serious spinal pathology include:
- Recent violent trauma (such as a vehicle accident or fall from a height).
- Minor trauma, or even just strenuous lifting, in people with osteoporosis.
- Age at onset less than 20 or over 50 years (new back pain).
- History of cancer, drug abuse, HIV, immunosuppression or prolonged use of corticosteroids.
- Constitutional symptoms – eg, fever, chills, unexplained weight loss.
- Recent bacterial infection.
- Pain that is:
- Constant, severe and progressive.
- Non-mechanical without relief from bed rest or postural modification.
- Unchanged despite treatment for 2-4 weeks.
- Accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis).
- Structural deformity.
- Severe or progressive neurological deficit in the lower extremities.
What organ is under your lowest rib?
How the spleen works – Your spleen is tucked below your rib cage next to your stomach on the left side of your belly. Its size generally relates to your height, weight and sex. This soft, spongy organ performs several critical jobs, such as:
Filtering out and destroying old, damaged blood cells Preventing infection by producing white blood cells (lymphocytes) and acting as a first line of defense against disease-causing organisms Storing red blood cells and platelets, which help your blood clot
An enlarged spleen affects each of these jobs. When it’s enlarged, your spleen may not function as usual.
Can bad posture cause rib pain?
Mid/Upper Back, Rib & Chest Pain: Causes & Recommended Treatment – Mid and upper back pain, rib pain, and chest pain (possibly extending into the shoulder) are often caused by poor posture or daily repetitive activities that strain your muscular-skeletal system.
- If the pain begins gradually without explanation and worsens over a long period of time, this is the most likely cause.
- If the onset of pain occurs more suddenly, it could be related to a sudden injury or strain.
- The pain can be felt on one or both sides of the back, the shoulders, the chest or the ribs.
Stiffness in the shoulder, chest, and/or upper back due to muscle tightness can reduce the ability to perform basic tasks, such as getting dressed or driving. Taking over-the-counter medications can help in the short term, but it is far better to address the root cause of your back or chest pain and find longer-term relief.
What causes pain under right back rib cage?
10. Appendicitis – If the appendix, which is a part of the small intestine, becomes infected, it can result in pain on the right side of your body. While the pain is usually located on the lower right side, the pain can radiate upwards beneath your rib cage. An infected or inflamed appendix should be treated immediately as the appendix can burst.
What are 5 red flags of low back pain?
Author: David Della-Giustina, MD Yale University Citation: Della-Giustina D. Acute low back pain: recognizing the “red flags” in the workup ABSTRACT: A focused history and physical examination directed towards uncovering signs that suggest a serious underlying cause of low back pain are crucial.
“Red flags” include pain that lasts more than 6 weeks; pain in persons younger than 18 years or older than 50 years; pain that radiates below the knee; a history of major trauma; constitutional symptoms; atypical pain (eg, that which occurs at night or that is unrelenting); the presence of a severe or rapidly progressive neurologic deficit; urinary and/or fecal incontinence; poor rectal tone; and a history of malignancy.
These markers provide a cost-effective means of guiding your selection of laboratory and diagnostic imaging studies. Key words: back pain, epidural compression, sciatica With an annual incidence of 5%, low back pain affects up to 90% of the population at some point in time in their lives.
- It is the fifth most common cause for physician visits in the country and 7.6% of US adults reported at least one episode of severe acute low back pain within a 1-year period.1-3 The economic impact of low back pain is enormous.
- It is the most common cause of work-related disability in persons younger than 45 years and the second most common cause of temporary disability (after upper respiratory tract disease) for all ages.
Approximately 2% of the US work force is compensated for back injuries annually. In 1998 the direct health care costs attributable to low back pain in the United States were an estimated $26.3 billion.1-3 Some studies show that in up to 85% to 90% of patients with acute low back pain, no clear cause is ever determined.1-4 Although symptoms usually resolve within 4 to 6 weeks, all patients with back pain should be evaluated thoroughly so that significant neurologic or life-threatening diseases may be ruled out.
The “red flags” of back pain are important historical and physical features that point to potentially dangerous conditions. Identification of a red flag warrants close attention and further diagnostic testing. These red flags were defined in a set of guidelines on acute low back pain published by the Agency for Health Care Policy and Research.4 In this article, I discuss the approach to the patient who presents with low back pain—with particular emphasis on red flags.
I also review the most common diagnostic procedures. In my article on page 457, I will describe the evaluation and treatment of common and worrisome back pain syndromes as well as the less common, but nonetheless important, presentations of back pain in children and in patients with a history of cancer. (Click to enlarge) Duration of symptoms, Low back pain falls into 3 categories based on its duration:
- Acute pain lasts less than 6 weeks.
- Subacute pain continues for 6 to 12 weeks.
- Chronic pain persists for more than 12 weeks.
Pain that lasts longer than 6 weeks raises a red flag because 80% to 90% of all episodes of low back pain resolve within 6 weeks. If the patient has been assessed for low back pain previously, and pain persists for more than 6 weeks, he or she requires further evaluation.
- However, if the patient has had pain for 4 to 6 weeks without appropriate treatment, it is reasonable to delay the workup and observe him closely—provided there are no other red flags.
- Prescribe analgesia and activity modification measures at the initial visit.
- If there is no dramatic improvement after 2 weeks, begin the diagnostic workup.
In the patient who has chronic symptoms but who has already undergone a complete evaluation, review the workup to ensure that it has been thorough and that vital clues or signs have not been missed. Age, Back pain in patients younger than 18 years or older than 50 years constitutes a red flag.
- Patients under age 18 have a higher incidence of congenital and bony abnormalities, such as spondylolisthesis or spondylolysis, than older patients.
- In patients older than 50 years, nonmechanical causes, such as a rupturing abdominal aortic aneurysm or other intra-abdominal processes, are more common.
- Spinal stenosis resulting from hypertrophic degenerative processes and from degenerative spondylolisthesis is more common in persons older than 65 years.
Location and radiation of the pain, Pain that originates from muscular or ligamentous strain or from disc disease without nerve involvement is located primarily in the back, possibly with radiation into the buttocks or thighs. Pain that radiates below the knee is a red flag for a herniated disc or nerve root compression below the L3 nerve root.
- This is based on the dermatomal distribution of the nerve roots and the fact that the pain associated with inflammation radiates along the entire pathway of the nerve.
- More than 90% of herniated discs occur at the L4-5 or the L5-S1 disk space, thereby impinging on the L5 or S1 nerve root and producing a radiculopathy that extends into the lower leg and foot along the pathway of the involved nerve root.1,5 The location of the pain helps distinguish mechanical low back pain from sciatica, which is radicular pain that radiates into the legs in the distribution of a lumbar or sacral nerve root and is often accompanied by sensory and motor deficits.1,5 Sciatica may be associated with low back pain, but patients with sciatica typically complain primarily about the leg symptoms more so than the back pain.
Although the lifetime prevalence of sciatica is 40%, only 1% of patients with low back pain have associated sciatic symptoms.1,5,6 History of trauma, Major trauma is a red flag for the possibility of fracture and should prompt you to order plain radiographs of the involved spine.
- Minor trauma in elderly patients, such as falling from a standing or seated position, should also raise concern for fracture.
- This is attributable to the bony changes—predominantly osteoporosis—associated with aging.
- Systemic complaints,
- Constitutional symptoms—such as fever, chills, night sweats, malaise, or undesired weight loss—suggest infection or malignancy.
These symptoms are of even greater concern if the patient has additional risk factors for infection, such as diabetes, recent bacterial infection, immunocompromised status, or injection drug use. Back pain in an injection drug user is generally assumed to be vertebral osteomyelitis or spinal epidural abscess until these conditions are ruled out with imaging studies.
- A recent genitourinary or GI procedure may predispose the patient to infection secondary to bacteremia.
- Atypical pain features.
- Benign low back pain is typically described as a dull, aching pain that generally worsens with movement but improves when the patient is lying still.
- Red flags for tumor and infection include pain that occurs at night, awakens the patient from sleep, or is unrelenting despite appropriate analgesia and rest.
The pain of a herniated disc may be worsened by coughing, sitting, or the Valsalva maneuver and is relieved by lying supine.5-7 Spinal stenosis is associated with bilateral sciatic pain that is worsened by activities such as walking, prolonged standing, and back extension and is relieved by rest and forward flexion.
- In my experience, night pain and unrelenting pain are the most worrisome symptoms that are commonly ignored in the evaluation of patients with back pain.
- Associated neurologic deficits.
- Most patients with benign low back pain have no associated neurologic deficits.
- Any severe or rapidly progressive neurologic deficit or complaint raises a red flag.
Rule out an epidural compression syndrome such as spinal cord compression, cauda equina syndrome, or conus medullaris syndrome in a patient who reports bowel or bladder incontinence with low back pain. Patients with a history of urinary incontinence (whether just 1 episode or many) may be evaluated by measuring a postvoid residual volume.
A large postvoid residual indicates overflow incontinence which, in the setting of low back pain, suggests significant neurologic compromise and mandates an immediate evaluation for an epidural compression syndrome. A negative postvoid residual rules out significant neurologic compromise.1,8 Other neurologic complaints, such as paresthesias, numbness, weakness, and gait disturbances, need to be fully explored during the history taking and physical examination to determine whether the symptoms involve single or multiple nerve roots.
History of cancer. Patients with a history of cancer of the breast, lung, thyroid, kidney, or prostate; myeloma; lymphoma; or sarcoma are at high risk for metastatic disease to the spine. In over 90% of these patients, back pain is the initial symptom.1,9,10 The evaluation of these patients will be covered in my article on page 457.
Urinary, abdominal, or chest complaints. Although there are no specific red flags, it is important to review these areas to avoid overlooking disease processes referring or radiating to the back. The most serious of these is a ruptured abdominal aortic aneurysm. Other potential causes of pain referred to the back include pancreatitis, a posterior lower lobe pneumonia, nephrolithiasis, and renal infarct.
PHYSICAL EXAMINATION The examination is neither complicated nor prolonged. It is directed toward ruling out red flags and identifying specific neurologic deficits ( Table 2 ). Fever strongly suggests infection. Unfortunately, this sign is not very sensitive; it ranges from 27% for tuberculous osteomyelitis to 50% for pyogenic osteomyelitis and 83% for spinal epidural abscess.8 General appearance. The patient with benign back pain is most comfortable when lying still.
- Consider abdominal aortic aneurysm, nephrolithiasis and acute infection in patients who are in extreme pain. Abdomen.
- All patients require an abdominal examination that includes auscultation for bruits and palpation for masses, tenderness, or a pulsatile aorta that may suggest an aortic aneurysm. Back.
Examine the back for any signs of underlying disease. Erythema, warmth, and purulent drainage are signs of infection; contusion or swelling raises a red flag for trauma. Palpation and percussion over the vertebral bodies may reveal a possible cause of pain.
Point tenderness to percussion is found with fractures and bacterial infection, with a sensitivity of 86% and specificity of 60% for infection.8 Finally, perform a straight leg raise. With the patient lying in the supine position, passively lift each leg in turn to approximately 70 degrees in an attempt to reproduce the pain.
A positive result consists of the reproduction of the patient’s sciatic pain or radicular pain down the affected leg that radiates below the knee. The radicular pain is worsened by ankle dorsiflexion and improved with ankle plantar flexion or decreased elevation.
- Reproduction of the patient’s back pain or pain in the hamstring area does not constitute a positive result.
- A positive straight leg raise is about 80% sensitive for an L4-5 or L5-S1 herniated disc.
- Radicular pain in the affected leg when the asymptomatic leg is lifted (positive crossed straight leg raise) is highly specific (but not sensitive) for nerve root compression by a herniated disk.1,2,5,6 Neurologic examination.
This is the most important portion of the examination. It will allow you to identify an impending surgical emergency, such as cauda equina syndrome, as well as to define anatomic deficits, such as those that are found with a herniated disc. Test sensation by using light touch initially, followed by a pinprick, temperature, proprioception, and vibration if there are abnormalities on the initial exam.
- The L1 through L3 nerve roots supply sensation over the anterior thigh and provide strength to the hip flexors. There is no well-defined reflex for these nerve roots.
- The L4 nerve root is responsible for sensation over the medial surface of the leg and foot, including the medial surface of the great toe, but not the first dorsal web space. The motor component of L4 involves leg extension (L2 through L4) and ankle dorsiflexion and inversion. The patellar reflex is innervated predominantly by the L4 nerve root, although there is some contribution from L2 and L3.
- The L5 nerve root supplies sensation over the lateral leg and the dorsum of the foot, including the first dorsal web space. The muscular innervation for L5 is the extensor hallucis longus (great toe dorsiflexion) and dorsiflexors of the foot. There is no well-defined reflex for L5.
- The S1 dermatome covers the plantar and lateral surface of the foot. It innervates the peroneal muscles, which evert the foot and, along with the S2 nerve root, is responsible for the muscles that plantar flex the foot and allow toe walking. The S1 nerve root innervates the Achilles tendon reflex.
- The S2 through S4 nerve roots supply sensation to the perineum, making the 3 concentric rings surrounding the rectum. They are responsible for innervating the bladder and intrinsic muscle of the foot. These nerves innervate the anal wink reflex that is obtained by gently stroking the skin on the outside of the anus, causing a reflex contraction of the external anal sphincter.
Perform a rectal examination to evaluate for rectal tone and sensation, prostatic and rectal masses and to rule out perirectal abscess. A rectal exam is not indicated for all patients with low back pain. Rather, it is indicated in those patients with red flags, especially those with neurologic complaints or severe pain. DIAGNOSTIC STUDIES Laboratory tests. Order a complete blood cell count, erythrocyte sedimentation rate (ESR), and urinalysis if you suspect infection or tumor. The white blood cell count may be normal or elevated in patients with infection; the ESR is almost always elevated in patients with osteomyelitis and epidural abscess.11,12 C-reactive protein levels may be elevated in patients with acute infection; however, there are no studies to support a definitive association.
The one caution in using these tests is that they may not be elevated in those who have severe immunocompromise. Laboratory test results are generally normal in patients with neoplastic disease involving the spine; however, the ESR may be elevated.1,13 Order a urinalysis to rule out urinary tract infection as a source of infection that may have seeded the spine or primary renal disease referred to the back.
If the laboratory results are normal but you suspect infection or tumor, order an MRI scan of the spine. Radiographs. Obtain plain radiographs if you suspect fracture. Only anteroposterior and lateral films of the lumbar spine are necessary. Oblique projections are rarely indicated because they add little information and more than double gonadal radiation exposure and cost.6 The previous standard for imaging for tumors and infection was to start with plain radiographs and then to move on to more advanced imaging if they were normal and there was still suspicion.
- However, plain radiography is much less sensitive and specific for detecting disease, especially early in the process when morbidity can be minimized.
- Thus, one should go directly to MRI to make the definitive diagnosis. MRI.
- This is the preferred imaging modality for most patients with low back pain.
- It offers the best resolution of lesions in the vertebral bodies, soft tissue, spinal canal, and spinal cord and provides an excellent visualization of disc disease.
Emergent MRI is the modality of choice for evaluation of suspected spinal infection (vertebral osteomyelitis or epidural abscess) and epidural compression syndrome. MRI is indicated for routine or urgent use in the evaluation of neoplastic processes of the spine and of disc disease or when the patient’s symptoms fail to resolve after 6 to 8 weeks.
- CT scanning.
- CT is superior to MRI in evaluating bony detail of the spine.
- It is most useful in evaluating vertebral fractures, the facet joints, and the posterior elements of the spine.
- Its widespread availability makes it useful in emergencies when MRI is either unavailable or unsuitable.
- CT myelography is the best alternative when lesions involving the spinal canal are suspected and MRI is unavailable or if the patient is unable to undergo MRI.
If there is any concern for epidural compression or spinal infection, then one should go directly to MRI because CT without myelography will miss lesions inside the spinal canal and may falsely reassure the provider that there are no lesions. Radionuclide imaging.
This is primarily used to localize infectious or metastatic lesions of the spine. Radionuclide imaging has a high sensitivity for these lesions; however, because its specificity is low, a confirmatory test, such as MRI or CT, is usually required. Radionuclide imaging is also useful in evaluating suspected stress fractures in adolescents with low back pain.
Generally, however, MRI has replaced radionuclide imaging. REFERENCES:
- Chou R, Quaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med,2007;147(7):478-491.
- Deyo RA, Weinstein JN. Low back pain. N Engl J Med,2001;344(5):363-370.
- Andersson GB. Epidemiological features of chronic low-back pain. Lancet,1999;354(9178):581-585.
- Bigos SJ. United States Agency for Health Care Policy and Research. Acute low back problems in adults. Clinical practice guideline. Rockville, Md: US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. viii, 1994:160.
- Deyo RA, Loeser JD, Bigos SJ. Herniated lumbar intervertebral disk. Ann Intern Med,1990;112(8):598-603.
- Frymoyer JW. Back pain and sciatica. N Engl J Med,1988;318(5):291-300.
- Mazanec DJ. Back pain: medical evaluation and therapy. Cleve Clin J Med,1995;62(3):163-168.
- Deyo RA, RainvilleJ, Kent DL. What can the history and physical examination tell us about low back pain? JAMA,1992;268(6):760-765.
- Chamberlain MC. Neoplastic meningitis and metastatic epidural spinal cord compression. Hematol Oncol Clin North Am,2012;26(4):917-931.
- Penas-Prado M, Loghin ME. Spinal cord compression in cancer patients: review of diagnosis and treatment. Curr Oncol Rep,2008;10(1):78-85.
- Darouiche RO. Spinal epidural abscess. N Engl J Med,2006;355(19):2012-2020.
- Jaramillo-de la Torre JJ, Bohinski RJ, Kuntz CT. Vertebral osteomyelitis. Neurosurg Clin N Am,2006;17(3):339-351.
- Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med,1988;3(3):230-238.
What is the T4 syndrome?
What Is T4 Syndrome? – T4 syndrome is a musculoskeletal related dysfunction in which neurological structures are affected. This is caused by thoracic vertebrae being hypomobile, causing impingement on nerve fibers. Hypomobility can be caused by hunched posture, immobility, arthritic related disease, and inherited by genetics.
Why does my lower back hurt on the right side below my ribs?
Pelvic pain during pregnancy – Some people experience pelvic pain during pregnancy. Pelvic pain can affect one or both sides of the lower back. This pain may also affect the perineum or radiate to the thighs. It may become worse while a person is walking, standing up, or rolling onto their side. A person may be able to reduce pelvic pain during pregnancy by:
doing exercises that strengthen the pelvic floorstretchingtaking warm bathswearing flat, comfortable shoesavoiding standing for too longgetting plenty of rest
People can also try applying ice or heat packs to help ease the pain. OTC acetaminophen is generally safe to take during pregnancy. However, it is advisable to consult a doctor before taking any medications while pregnant. Testicular torsion can cause back pain on the lower right side in males.
severe and unexpected pain in the testicle or groinpain that radiates to the right or left side of the backswelling of the scrotumnauseavomitingblood in the semenpain in the low abdomen
Testicular torsion is a medical emergency, and anyone who experiences these symptoms should seek immediate medical attention. Treatment involves a surgical procedure to either untwist the spermatic cord or remove the testicle. People with severe, persistent, or worsening lower back pain should consult a doctor right away.
painful urinationcloudy, bloody, or foul-smelling urinestools containing blood or pusfevernauseavomitingpain during or after sexsevere groin pain irregular periods
Lower back pain is very common, Possible causes of lower back pain on the right side include sprains and strains, kidney stones, infections, and conditions that affect the intestines or reproductive organs. People should consult a doctor if they experience lower back pain that does not improve with rest or affects their daily life.