Non-Neuromusculoskletal Sources of Neck and back pain

Question 1

What are some common serious spinal pathologies and their incidence

Answer 1

• 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)

Question 2

What cancers typically cause spinal metastases

Answer 2

• breast
• lung
• prostate

Question 3

Cancer and LBP red flags

Answer 3

• 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

Question 4

How can cancer cause pain

Answer 4

• 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

Question 5

How do visceral structures refer symptoms

Answer 5

• embryologic development
• multisegmental innervation
• direct pressure/shared pathways

Question 6

Embryologic development as a referred symptoms theory

Answer 6

• pain is referred to site where organ was located in fetal development
• where the tissue developed

Question 7

Multisegmental innervation

Answer 7

• major visceral organs are innervated by afferent fibers from multiple spinal levels
• shared innervation

Question 8

Direct pressure and shared pathways as a symptom referral

Answer 8

• organs impinging the respiratory diaphragm can refer pain
• C3-C5 is diaphragm innervation and can cause symptoms elsewhere

Question 9

Potential sources of neck and back symptoms

Answer 9

• lung
• liver
• heart
• esophagus
• stomach
• kidney
• gall bladder
• pancreas
• GI tract
• uterus
• spleen
• aorta
• diaphragm
• bladder
• ureter
• prostate

Question 10

Neck symptoms can refer from

Answer 10

• lung
• liver
• heart (usually left side)
• esophagus

Question 11

Thoracic and rib pain can refer from what structures

Answer 11

• heart
• lung
• stomach
• kidney
• gall bladder
• pancreas
• esophagus

Question 12

lumbar pain can refer from

Answer 12

• GI
• bladder
• ureter
• uterus
• kidney
• aortic aneurysm

Question 13

Shoulder pain can refer from

Answer 13

• heart
• lung
• gall bladder
• spleen
• pancreas
• diaphragm
• esophagus
• liver
• kidney
• aortic aneurysm

Question 14

Buttock, hip and thigh pain can refer from

Answer 14

• GI
• uterus
• prostate
• kidney

Question 15

History of symptoms to figure out if is mechanical or medical

Answer 15

• 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

Question 16

mechanical onset of symptoms

Answer 16

• sudden with mechanical event
• gradual from cumulative trauma

Question 17

Systemic onset of symptoms

Answer 17

• slowly without mechanical event
• could be cancer growing

Question 18

Vascular onset of symptoms

Answer 18

• sudden and sharp without mechanical event

Question 19

Frequency of mechanical symptoms

Answer 19

• intermittent
• most MSK pain relieved or diminished with certain positions that will remove stress
• constant pain = systemic as often no influence with positional changes

Question 20

Red flags for back pain

Answer 20

• 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

Question 21

Viscerogenic causes of neck and back pain?

Answer 21

• cancer
• cardiovascular
• pulmonary
• Renal/urologic
• Gastrointestinal
• gynecologic

Question 22

Cervical Cancer

What types of cancer

Answer 22

• Metastatic Lesion
• Cervical Bone tumors
• cervical cord tumors
• lung cancer; pancoast tumor
• esophageal cancer
• thyroid cancer

Question 23

Cancer: Thoracic

Answer 23

• mediastinal tumors
• metastatic extension
• pancreatic cancer
• breast cancer

Question 24

Lumbar Cancer

Answer 24

• metastatic lesion
• prostate cancer
• testitular cancer
• pancreatic cancer
• colorectal cancer
• multiple myeloma
• lymphoma

Question 25

Cardiopulmonary: symptoms in the cervical/thoracic

Answer 25

• angina
• myocardial infarction
• aortic aneurysm

Question 26

Cardiopulmonary: lumbar symptoms

Answer 26

• abdominal aortic aneurysm
• endocarditis
• myocarditis
• peripheral vascular: post-op bleeding from anterior spine surgery

Question 27

Pulmonary: cervical symptoms

can be caused by

Answer 27

• lung cancer; pancoast tumor
• tracheobronchial irritation
• chronic bronchitis
• pneumothorax

Question 28

Pulmonary conditions that can refer to thoracic symptoms

Answer 28

• respiratory or lung infection
• emphysema
• chronic bronchitis
• pleurisy
• pneumothorax
• pneumonia

Question 29

Renal/urologic: thoracic

Answer 29

• acute pyelonephritis
• kidney disease

Question 30

Renal/urologic: lumbar

Answer 30

• kidney disorders:
• acute pyelonephritis
• perinephritic abcess
• nephrolithiasis
• ureteral colic
• UTI
• dialysis
• renal tumors

Question 31

Gastrointestinal in cervical region

Answer 31

• esophagitis
• esophageal cancer

Question 32

GI: thoracic region

conditions

Answer 32

• esophagitis
• esophageal spasm
• peptic ulcer
• acute cholescystitis
• biliary colic
• pancreatic disease

Question 33

GI: lumbar

conditions that could refer to this area

Answer 33

• small intestin: obstruction, irritable bowel syndrome, crohn’s disease
• colon: diverticular disease
• pancreatic disease
• appendicitis

Question 34

Gynecologic: lumbar

Answer 34

• cancer
• retroversion of uterus
• uterine fibroids
• ovarian cysts
• endometriosis
• pelvic inflammatory disease

Question 35

Gynecologic lumbar

Answer 35

• incest/sexual assult
• rectocele, cystocele
• uterine prolaspe
• normal pregnancy
• multiparity

Question 36

Other things that can refer to the spine

Answer 36

• infection: vertebral osteomyelitis, meningitis, herpes zoster, HIV, lyme disease
• osteoporosis
• fibromyalgia
• psychogenic
• fracture