special subjects
Work Related Back Pain
Diagnosis of Work Related Back Pain
Clinical evaluation Sometimes imaging tests The evaluation of work-related back injury is similar to that for any other back problem. Medical history should include a focused occupational history emphasizing the patient's specific job task and exactly what the patient was doing when injured. A thorough review of the patient’s past occupational medical history is essential. A physical examination should include a focused musculoskeletal and Introduction to the Neurologic Examination . If the injury was caused by direct trauma (eg, a significant direct blow to the back, a fall from a height) or if justified by clinical findings (eg, neurologic deficits, findings suggesting fragility fracture), imaging (plain x-rays, CT, MRI) is indicated; however, for injury without such causes, imaging is not indicated. Plain x-rays have a notoriously low yield when done to assess work-related back injury and pain. In many industries, preemployment plain x-rays of the back used to be done for workers at risk of back injury. This practice is no longer recommended because it provides little or no clinically helpful information and exposes workers to unnecessary radiation. Indications for imaging are the same for occupational-related back pain as for nonoccupational-related back pain. , and in these cases, detailed physician notes often guide the outcome. Disability Assessment , as in any other case, may also be done but is a separate assessment. 