Backache is one of the most common complaints seen in general practice and orthopaedic clinics. It accounts for about 20% of referrals to orthopaedic clinics. Most causes are either traumatic or degenerative but other causes are numerous and may occur as a result of pathology in almost any system of the body. The diagnosis is usually apparent from the history, although with spondylolisthesis, the symptoms, i.e. low lumbar backache, worse on standing, may not present until late childhood or early adult life. The speed of onset is important. Sudden onset back pain may be due to trauma or disc lesions, whereas gradual onset of pain may be due to conditions such as degenerative disease. Mechanical lesions impinging on the cord can result in neurological symptoms such as bladder dysfunction (urinary retention). Symptoms worse on movement and relieved by rest suggest a mechanical cause, whereas pain that is severe and unrelenting can occur with malignant causes. In addition, there may be symptoms (other than musculoskeletal) related to the underlying cause such as abdominal pain, dysuria or menorrhagia. There will usually be a clear history of trauma. Care must be taken in moving the patient. Neurological sequelae may be obvious. There may be a history of TB; the patient may have had night sweats or cough. Osteomyelitis of the spine may also occur in diabetes and the immunocompromised, in which case the organism is more commonly Staphylococcus aureus. With spinal TB, the patient is usually young and complains of malaise, fever, pain, tenderness and limitation of movement of the spine. Discitis usually presents with mild backache accompanied by leg pain. Ankylosing spondylitis usually affects young adult males. The sacroiliac joints are affected initially, then the whole spine. The patient usually presents with lumbar stiffness, especially when rising in the morning. Iritis and plantar fasciitis may also occur. Rheumatology disorders may present with symptoms in other joints.
Backache
Causes
History
Congenital
Acquired
General
Traumatic
Infective
Inflammatory
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Backache
