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Tell Me Where it Hurts? Part II
March 22, 2011 by Dr Matthew D. Long
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Tell Me Where it Hurts? Part II
March 22, 2011 by Dr Matthew D. Long
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Tell Me Where it Hurts? Part II
March 22, 2011 by Dr Matthew D. Long
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In our last blog posting (found here) we looked at the significance of midline lumbar pain as a sensitive and specific predictor of internal disc disruption. But intervertebral disc disease is not the only disorder in which pain distribution can be a useful indicator of its origin. A paper by Clark et al in the journal Rheumatology looked at whether a unique pattern of pain accompanied thoracic osteoporotic compression fractures.
The possibility of osteoporotic compression fracture is usually raised in post-menopausal women suffering from thoracic pain. But is the pain typically felt in the midline, or even over the spine at all?
Clark and colleagues found in their study sample that lateral waist pain was a reasonable indicator of vertebral body fracture. These women did not experience their discomfort over the spine, but quite lateral to it, as the diagram below shows.
The possibility of osteoporotic compression fracture is usually raised in post-menopausal women suffering from thoracic pain. But is the pain typically felt in the midline, or even over the spine at all?
Clark and colleagues found in their study sample that lateral waist pain was a reasonable indicator of vertebral body fracture. These women did not experience their discomfort over the spine, but quite lateral to it, as the diagram below shows.
Diagram courtesy of Rheumatology
While the sensitivity (44.8%) and specificity (84.6%) of this observation is not compelling, it does help us to consider osteoporotic fracture in patients who experience pain quite removed from the spine, and who previously may have been thought to have a rib lesion of sorts.
Ultimately the ability to diagnose is an extension of our ability to predict - based upon our intelligent gathering and weighting of observational data. We'll look more closely at the evolution of clinical prediction rules in future blog articles, but for now, store this snippet of information away for the next time you see a post-menopausal woman complaining of lateral waist pain.
Dr Matthew D. Long
BSc (Syd) M.Chiro (Macq)
Ultimately the ability to diagnose is an extension of our ability to predict - based upon our intelligent gathering and weighting of observational data. We'll look more closely at the evolution of clinical prediction rules in future blog articles, but for now, store this snippet of information away for the next time you see a post-menopausal woman complaining of lateral waist pain.
Dr Matthew D. Long
BSc (Syd) M.Chiro (Macq)
References:
1. Clark EM, Hutchinson AP, McCloskey EV, Stone MD, Martin JC, Bhalla AK, Tobias JH. Lateral back pain identifies prevalent vertebral fractures in post-menopausal women: cross-sectional analysis of a primary care-based cohort. Rheumatology. 2010 vol. 49 (3) pp. 505-12
1. Clark EM, Hutchinson AP, McCloskey EV, Stone MD, Martin JC, Bhalla AK, Tobias JH. Lateral back pain identifies prevalent vertebral fractures in post-menopausal women: cross-sectional analysis of a primary care-based cohort. Rheumatology. 2010 vol. 49 (3) pp. 505-12