Cam or pincer deformity, acetabular retroversion, coxa profunda Hip labral tear Dull or sharp, referred pain; pain with weight bearing Mechanical symptoms, such as catching or painful clicking; history of hip dislocation Trendelenburg or antalgic gait, loss of internal rotation, positive FADIR and FABER tests MRI: Can show a labral tear Magnetic resonance arthrography: No bony involvement MRI:
Axial and sagittal images of the same patient. It may be appropriate to trial a period of conservative care prior to MRI for patients with radiculopathy 18 Advantages compared to CT include No ionising radiation Better soft tissue contrast — modality of choice for detection of spinal infections, metastases, nerve root disorders and disc abnormalities Disadvantages compared to CT include 17 Lower spatial resolution — cortical bone lesions are not as well visualised.
Where bony anatomy is critical, CT may be preferred Claustrophobia Longer scanning time needed Contraindicated in the presence of a ferromagnetic substance, e.
Pacemaker, aneurysm clip, cochlear implant, ocular foreign body, spinal cord stimulator and some stent materials Most findings on MRI in patients presenting with low back pain represent progressive age-related changes and are not associated with acute events, although primary radiculopathies may have new root compression findings 19 MRI is recommended for vertebral inflammatory and infectious processes.
Disc extrusions have a 'neck' and are rare in asymptomatic patients where as protrusions are broad based and commonly occur in asymptomatic people ComputedTomography Advantages of CT over MRI include Superior bony detailing of the spine, particularly the facet joints 32 and the posterior elements Faster acquisition time and less sensitive to patient movements CT is useful for identifying bone structural problems and for post-surgical evaluation of bone graft integrity, surgical fusion and instrumentation 533 CT has a similar accuracy to MRI and CT myelography in identification of lumbar disc herniation.
This allows the nerve root sleeves to be visualised and a lack of filling, displacement, or swelling of a nerve root may indicate adjacent pathology 2835 MRI is the preferred first line investigation of suspected radiculopathy or spinal stenosis due to its excellent soft tissue definition and non-invasiveness.
This is similar to that of non-invasive helical CT 2836 Limitations Associated small risk of exacerbating the neurological deficit Lumbar Discography Lumbar provocation discography, which includes disc stimulation and morphological evaluation, may distinguish a chronically painful lumbar disc from other potential sources of pain where less invasive studies have been indeterminate 38 However, careful consideration should be given to the risks of the procedure.
A recent study suggested that discography may cause accelerated degenerative changes, disc herniation, loss of disc height and development of reactive end-plate changes in tested discs 39 bonescan Bone Scan Sensitive but not very specific for detecting infection, malignancy or occult fractures. Generally MRI is preferred for localised lower back pain Bone scintigraphy is useful in the evaluation of suspected widespread or multifocal osseous infections or metastases, or where MRI is contraindicated or unavailable 17 References Date of literature search: May The search methodology is available on request.
Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain.
Acute low back pain: Imaging strategies for low-back pain: Influence of imaging on clinical decision making in the treatment of lower back pain. Americal College of Radiology Appropriateness Criteria: Low back pain [online publication].
Reston, VA; [cited April 4]. European guidelines for the management of acute nonspecific low back pain in primary care. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.
Evidence-based Management of Acute Musculoskeletal Pain [online publication]. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev.Back Pain (Mayo Foundation for Medical Education and Research); Handout on Health: Back Pain (National Institute of Arthritis and Musculoskeletal and Skin Diseases); Low Back Pain (American Academy of Family Physicians) Also in Spanish; Low Back Pain Fact Sheet (National Institute of Neurological Disorders and Stroke) Also in Spanish.
Chronic pain becomes more common as people grow older, at least in part because health problems that can cause pain, such as osteoarthritis, become more common with advancing age. Upper back pain during pregnancy can occur at any point, but is most common in the third trimester.
This occurs for several reasons. Hip pain during pregnancy is a common symptom that you may experience. This discomfort is most often felt late in pregnancy, specifically during the third trimester.
This occurs because your body is . Back pain is pain felt in the initiativeblog.com is divided into neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected.
The lumbar area is the most common area for pain, as it supports most of the weight in the upper body. Episodes of back pain may be acute, sub-acute, or chronic depending on the duration. Joint Hypermobility Syndrome and Pelvic Pain. Abdominal and pelvic pain can have a variety of causes.
Joint hypermobility syndrome can often be an undetected and underdiagnosed comorbidity in chronic pelvic pain conditions (I.e. like endometriosis).