musculoskeletal and connective tissue disorders
Evaluation of Neck and Back Pain
Etiology of Neck and Back Pain
Most neck and back pain is caused by disorders of spinal structures. Muscle pain is a common symptom and is typically caused by irritation of the deeper muscles by the dorsal rami of the spinal nerve and in the more superficial muscles from a local reaction to the spine injury. Strains are very rare in the cervical and lumbar spine. Fibromyalgia can coexist with neck and back pain but is less likely to cause isolated pain in the neck or back. Occasionally, pain is referred from Most spinal disorders result from Mechanical problems Only a few involve nonmechanical problems, such as infection, inflammation, cancer, or fragility fractures due to Osteoporosis or cancer. Most pain caused by mechanical spine disorders is caused by Disk pain Nerve root pain Osteoarthritis (OA) of the joints The following are the most common causes of neck and low back pain. Cervical Herniated Nucleus Pulposus None Vertebral Compression Fractures (usually thoracic or lumbar) Lumbar Spinal Stenosis None Osteoarthritis (OA) throughout the spine Spondylolisthesis None All of these disorders also can be present without causing pain. Several anatomic abnormalities (eg, Cervical Herniated Nucleus Pulposus , osteophytes, spondylolysis, facet abnormalities) are commonly present in people without neck or back pain, and thus are questionable as the etiology of pain. However, the etiology of back pain, particularly if mechanical, is often multifactorial, with underlying disorders exacerbated by fatigue, physical deconditioning, muscle pain, poor posture, weakness of stabilizing muscles, decreased flexibility, and sometimes psychosocial stress or psychiatric abnormality. Thus, identifying a single cause is often difficult or impossible. A generalized myofascial pain syndrome, such as Fibromyalgia , frequently includes neck and/or back pain. Serious causes may require timely treatment to prevent disability or death. Seriousextraspinal disordersinclude the following: Abdominal Aortic Aneurysms (AAA) None Aortic Dissection None Carotid or vertebral artery dissection Acute Bacterial Meningitis None Angina Pectoris or Certain gastrointestinal (GI) disorders (eg, Acute Cholecystitis , Certain pelvic disorders (eg, Ectopic Pregnancy , Certain pulmonary disorders (eg, Viral Pleuritis , Certain urinary tract disorders (eg, Prostatitis , Extraspinal cancer metastases Retroperitoneal inflammatory or infiltrative disorders (eg, retroperitoneal fibrosis, IgG4-Related Disease , hematoma, adenopathy) Inflammatory muscle disorders (eg, polymyositis and other inflammatory myopathies, polymyalgia rheumatica) Seriousspinal disordersinclude the following: Infections (eg, diskitis, epidural abscess, Osteomyelitis ) Primary tumors ( Spinal Tumors ) Metastatic vertebral tumors (most often from breasts, lungs, or prostate) Mechanical spine disorders can be serious if they compress the spinal nerve roots or, particularly, the spinal cord. Spinal Cord Compression only occurs in the cervical, thoracic, and high lumbar spine and may result from severe spinal stenosis or disorders such as tumors and Neck or back pain can result from many other disorders, such as Paget Disease of Bone None Cervical Dystonia None Thoracic Outlet Compression Syndromes (TOS) None Overview of Temporomandibular Disorders (TMDs) None Herpes Zoster (even before the rash) Spondyloarthropathies ( Ankylosing Spondylitis , enteropathic arthritis, Brachial Plexus and Lumbosacral Plexus Disorders (eg, Parsonage Turner syndrome) 