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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #27

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Have a patient complaining of back or neck pain?

Forgo doing x-rays if there was no significant traumatic event and the patient has no mid-line tenderness.

Usually a simple back or neck strain will resolve on its own and does not elicit mid-line tenderness. An x-ray will usually not provide you any valuable information.

If there was no significant impact to the spine, the chances of a fracture are very low (unless they are frail or elderly).

Therefore, when evaluating a patient who presents with complaints of back or neck pain, inquire about the injury mechanism (if there even is one) and tap those vertebrae!

It astonishes me the amount of lumbar and cervical x-rays that are performed for simple perispinal soft tissue injuries. Save your patients the radiation exposure and money next time.

As always, use your clinical judgement!

2 Responses

  1. I have a co-worker that recently was having back pain and ended up finding metastatic cancer compressing her spine. What kind of symptoms would prompt further testing and not dismiss as soft tissue injury?

    1. Pain that starts spontaneously without any sort of injury mechanism could be an alarming symptom. I am curious though, did she have midline tenderness or significant pain out of proportion? Any additional symptoms?

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