Chest pain and back pain

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Understanding Chest Pain and Back Pain: Key Insights from Recent Research

Physical Examination Tests for Serious Pathology in Chest and Back Pain

Screening for Referral: Physical examination tests (PETs) are crucial for identifying serious pathologies in patients with chest or back pain. Commonly used tests include cardiac and pulmonary auscultation, heartbeats, and blood pressure measurements. However, there is a notable variation in the use of these tests among different healthcare professionals. Doctors and nurses often assess the range of motion of the thoracolumbar spine and hip less frequently compared to physiotherapists and chiropractors, who also use lung percussion and lymph node palpation. This inconsistency highlights the need for standardized PETs to ensure accurate diagnosis and referral.

Case Studies Highlighting Diagnostic Challenges

Acute Aortic Syndrome: A 26-year-old male presented with severe chest pain radiating to the upper back, described as a tearing sensation. His symptoms, including syncope and a widened mediastinum on chest x-ray, pointed towards a serious cardiovascular issue, potentially an acute aortic syndrome. This case underscores the importance of thorough cardiovascular examination in patients with chest and back pain.

Straight Back Syndrome: A 17-year-old female with left-sided chest pain and middle back pain was diagnosed with straight back syndrome. This condition, often under-diagnosed, can present with both chest and back pain, and symptoms can be alleviated with chiropractic therapy.

Inflammatory Back Pain and Anterior Chest Wall Pain

Spondyloarthritis (SpA): In patients with recent inflammatory back pain (IBP) suggestive of SpA, anterior chest wall (ACW) pain is prevalent. ACW pain is associated with more severe disease features, including enthesitis, thoracic spine involvement, and radiographic sacroiliitis. This pain can serve as a diagnostic feature for ankylosing spondylitis (AS).

Musculoskeletal Causes and Treatment Approaches

Scalenus Medius Muscle Spasm: Chest and back pain localized between the scapulae can often be attributed to hyperactivity of the dorsal scapular or long thoracic nerves, potentially due to spasm of the scalenus medius muscle. Treatments such as trigger point injections, physical therapy, and NSAIDs can be effective in managing this pain.

Thoracic Pain Screening: Physiotherapists play a critical role in screening for serious pathologies in patients with thoracic or chest pain. An in-depth subjective and objective examination is essential to differentiate between musculoskeletal and non-musculoskeletal origins of pain. Recognizing red flags can help in timely referral and management of serious conditions like spinal fractures or myocardial ischemia.

Impact of Chest Size on Back Pain in Women

Prolonged Standing: Women with larger chest sizes are more prone to developing back pain during prolonged standing due to higher levels of muscle co-contraction in the thoracic and lumbar regions. This neuromuscular mechanism can be targeted in non-invasive musculoskeletal rehabilitation to alleviate back pain in this population.

Conclusion

Chest and back pain can stem from a variety of causes, ranging from musculoskeletal issues to serious pathologies like cardiovascular diseases and spondyloarthritis. Accurate diagnosis through standardized physical examination tests and awareness of specific conditions like straight back syndrome and the impact of chest size on back pain are crucial. Healthcare professionals must employ a comprehensive approach to screening and managing these pains to ensure effective treatment and patient care.