Cardiovascular
Chest pain, heaviness, nausea, vomiting, sometimes mistaken for indigestion
Myocardial ischemia (can lead to myocardial infarction)
Sharp pain with inhalation, dyspnea, may occur secondary to pulmonary disease or trauma
Pneumothorax
Interscapular pain, nausea, vomiting, fever, sense of fullness, bloating, often triggered by eating (particularly high fat meal)
Cholecystitis
Pain, itching, hyperesthesia in dermatomal pattern, eventually resulting in rash/blistering
Herpes Zoster (shingles)
Non-specific back ache, increasing over 1-3 weeks, specific local tenderness over involved vertebrae, pain worse at night, may report history of recent infection
Osteomyelitis of vertebrae
Describe the difference between stable and unstable angina
• Stable angina - Pain is related to exertion and relieved with rest
• Unstable angina - Occurs at random, not related to activity, Usually a progression of stable angina. Risk factor for pending myocardial infarction!
Chest pain – can radiate to the back, Sudden onset, Unrelenting, Not relieved by positional change, most common in hypertensive men ages 40-70
Dissecting thoracic aneurysm
Fever, chills, sweats, pleuritic chest pain, cough, sputum production, hemoptysis, dyspnea, headache, or fatigue. Crackling, bubbling, rumbling sounds with inhalation.
Pneumonia
Epigastric pain, mid-back and R shoulder pain, changes with eating. Chronic NSAID use is a risk factor.
Peptic ulcer
Pain and hyperesthesia persisting >1 month after acute shingles resolved
Post-herpetic neuralgia
Constant, non-mechanical pain, pain at night, history of cancer
Spinal metastases
What are the 4 items that together have a 100% sensitivity for cancer as the cause of back pain?
Age >50
Previous history of cancer
Unexplained weight loss
Failure to improve after 1 month of conservative care
Imbalance between cardiac workload and oxygen supply to myocardial tissue, obstructed or decreased blood supply to the heart muscle primarily from atherosclerosis
Angina
Tachypnea, tachycardia, chest pain, shortness of breath
Pulmonary embolism
Presents as abdominal pain radiating to the back, worse with walking and lying supine, improved with sitting and leaning forward, may have nausea, vomiting, diarrhea. May also radiate to the left shoulder.
Pancreatitis
Sharp shoulder pain, ptosis, miosis, anhidrosis
Pancoast tumor
What types of cancer are most likely to metastasize to the thoracic spine?
Dull, aching, constant mid-back pain, possible fever and/or chills, frequent urination, hematuria, left shoulder pain
Pyelonephritis
What are possible predisposing factors or risk factors for discitis?
Post-operative after discectomy, bacteremia from UTI, low-grade viral or bacterial infection
Band of chest pain radiating to interscapular region, may have blood in stool and/or vomiting
Esophageal varices
*Signs of rupture/hemorrhage - restlessness, pallor, tachycardia, hypotension, cooling of the skin*