RIME - Back Pain
Marc Benayoun, MSIII
March 7, 2011
History Intake
Basic history
Onset of pain- abrupt or gradual; associate history
How long the pain persists and getting better or worse?
Location of pain
Does pain interfere with sports or normal activity?
Aggravating and relieving symptoms
Stiffness in the back in the mornings or after rest?
Age of patient (worrisome if patient is prepubescent and especially if younger than school age)
Associate history
Recent Traumatic Injury?
Associated fever?
Unintentional Weight Loss?
Bowel or bladder symptoms? (Indicating a neurologic component to the back pain)
TB exposure?
Recent or rapid increase in exercise intensity (without proper conditioning can lead to “Overuse” Syndrome)
Physical Exam
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Examine how the child sits, stands, and walks for abnormalities
Look for differences in shoulder height, scapular prominence, pelvic symmetry (can suggest scoliosis or leg length
discrepancy)
Midline skin lesions, such as dimples near the base of the spine or hair patches (indicative of spinal lesions)
Look for café au lait spots (NF1)
Do a full neuro exam to look for gait abnormalities (such as Trendelenberg gait), muscle fasciculations or atrophy,
toe walking, and straight-leg-raising test), muscle weakness in the distribution of a peripheral neuropathy or
radiculopathy, and check DTR’s
Palpate for points of tenderness along the spine
Check for full ROM in lower spine
Causes
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Traumatic Injury (muscle strain, ligament strain)
Musculoskeletal (Spondylolysis, Spondylolisthesis, Scoliosis, Disc Degeneration, Juvenile Kyphosis, Poor
Posture)
Infectious (Discitis, Osteomyelitis, Pott’s Disease, Sacroiliac Joint Infection. Pylenephritis, PID, viral Myalgia, or
Endocarditis)
Inflammatory (Ankylosing Spondylitis, Psoriatic Arthritis, IBD Arthritis, Reactive Arthritis)
Neoplastic (Osteoid Osteoma, Leukemia or Lymphoma, Ewing’s Sarcoma, osteosarcoma)
Neurologic (Disc Herniation, Epidural Abscess)
Differential Diagnosis and Management
Causes
S&S
Treatment
Muscle Strain
Recent Trauma,
Poor posture,
“Overuse”
Syndrome
Poor posture,
muscle spasm,
pain
Ibuprofen, ice
Fracture
Recent Trauma such as
automobile or bicycle
accident
Juvenile Kyphosis
Poor posture or
congenital
Pain, numbness, tingling,
or weakness, loss of
bladder or bowel control
Refer to orthopaedics
Round back from
kyphosis of thoracic
spine
NSAIDS and
Other
Infectious
Inflammatory
Neoplastic
Neurologic
Back pain, fever, weight loss,
joint pain, depends on etiology
All idiopathic back pain should
compress, and
rest, with gradual
reintroduction of
exercise
www.uptodate.com , pedsinreview
who may recommend
surgical correction,
percutaneous
vertebroplasty, or back
brace or plaster cast
along with NSAIDS or
muscle relaxants
exercise, surgery may
be warranted for
severe symptoms or
kyphosis greater than
75 degrees
warrant a CBC, ESR, UA, and
A/P and lateral spine X-rays.
Other tests to consider are HLA
B27, Rheumatoid Factor, ANA,
oblique X-ray films, CT,
electromyography, or
radionuclide scanning