Journal of Urgent Care Medicine

High-Risk Conditions Presenting as Back Pain

Urgent message: That back pain is common and typically without serious sequelae may result in misdiagnosis and mistreatment. ERICA MARSHBURN, BS, BA, AND JOHN SHUFELDT, MD, JD, MBA, FACEP Many high-risk conditions can present as back pain, is a very frequent presenting complaint in urgent care medicine. Most back pain is muscular in origin and responds well to conservative intervention. However, because of the frequency of the complaint and infrequency of serious sequelae, providers may …

Clinical Challenge: October, 2011

The patient, an otherwise-healthy 42-year-old, presented with bilateral back pain around the pelvis. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.

October 2010

The Case of a 51-year-old Man with Back Pain

Most new third-year medical students can recite the “red flags” of back pain: extremes of age, fever, history of cancer, history of trauma, failure to improve after one month of therapy. Few would fail to consider metastatic disease in a 64-yearold woman with a history of breast cancer and new-onset low back pain, but what about the 51-year-old male without a significant past medical history?

14-year-old boy with lower back pain stemming from fall

The patient is a 14-year-old boy who presents with low back pain after falling from “a high height” and landing on his feet. Exam is normal except for tenderness in the mid-lumbar region. View the image taken and consider what your diagnosis and next steps would be.

Clinical Challenge 2

The patient is a 61-year-old male who presents with back pain. The patient’s abdomen is soft. Vitals are stable. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 12-year-old Girl with Back Pain

Urgent message: Back pain in a pediatric patient requires a high index of suspicion. Ominous causes (e.g. cancer, infection), are far more common in the pediatric population. Conversely, mechanical low back pain is far less common, and is a diagnosis of exclusion. Forrest Nguyen, DO Introduction As urgent care physicians, we are responsible for anything that comes through the door. Often, the diagnosis proves to be routine – a viral infection, a sore throat, or …

December 2009

55-year-old female experienced blow to back from fall

The patient is a 55-year-old female who experienced a blow to the back when she fell while riding a bus. She complains of pain in her neck, shoulder, and back. On examination, you find that her vitals are stable and she has no significant past medical history. View the x-ray taken and consider what your diagnosis and next steps would be.

80-year-old man suffering lower back pain

The patient is an 80-year-old man who presents with a two-week history of low back pain. He is hemodynamically stable and has a normal neurological exam. His personal medical history reveals hypertension, for which he is being treated. Blood pressure is 140/80, pulse 63. View the x-ray taken and consider what your diagnosis and next steps would be.