CASE 67: BACK PAIN
History
A 48-year-old woman presented to her general practitioner (GP) with 3 months’ history of
back pain in the mid-thoracic region. The pain was intermittent, worse at night, and relieved
by ibuprofen, which she bought herself. She had no other symptoms, and no relevant past
or family history. She had never smoked, and drank 10–12 units of alcohol most weeks. She
worked part-time stacking the shelves in a supermarket and was a very active and compet-
itive tennis and badminton player.
Examination
She looked well. She indicated that the pain was over the vertebrae of T5/6, but there was
no tenderness, swelling or deformity. Her spinal movements were normal.
Her blood pressure was 136/76 mmHg. Cardiovascular, respiratory and abdomen exam-
ination were normal.
Spinal X-ray was arranged and showed no abnormality. The full blood count, urea creati-
nine and electrolytes, calcium, alkaline phosphatase and phosphate were all normal, as
was urine testing.INVESTIGATIONS
She was advised that the pain was musculoskeletal due to exertion at work and sport, and
she was prescribed diclofenac for the pain. She was advised to rest from her tennis and
badminton.
After a few weeks of improvement, the pain began to get worse, being more severe and
occurring for longer periods and seriously disturbing her sleep. She returned to her GP and
examination was as before except that there was now some tenderness over her mid-
thoracic spine. The GP arranged another X-ray of the spine (Fig. 67.1).