Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

214 Back or Neck Pain Bacterial Arthritis

differential diagnosis

■Mode of onset & duration of pain may suggest underlying disorder

➣Acute disorder: disc prolapse or local infection

➣Chronic disorder: musculoskeletal or neoplastic cause

■Cutaneous pain over back or neck may be due to shingles; develop-

ment of skin rash indicates diagnosis

■Primary infection of other sites (eg, lungs, bladder, skin) suggests

spinal osteomyelitis

■Osteoporosis common in the elderly or inactive, or in those w/ family

history or taking steroids

■Secondary tumors of spine more common than primary tumors

management

■Analgesics or NSAIDs for pain

■If fracture suspected, immobilize spine/neck for imaging studies

specific therapy

■Treat underlying disorder

■Surgical drainage for acute hematoma or abscess

■Spinal injury w/ cord compression may require decompression &

spinal fusion; high-dose steroids helpful in first 24 hrs

■Irradiation & steroids for tumors

■Soft collar for cervical spondylosis; surgery sometimes needed

follow-up

■Depends on causal disorder

complications and prognosis

■Depend on causal disorder

Bacterial Arthritis....................................

STEVEN R. YTTERBERG, MD

history & physical

History

■Bacteremia

■Extra-articular infections: skin infections, SBE, abscess

Risk Factors

■Pre-existing joint damage by inflammatory arthritis, joint prosthe-

ses, joint surgery

■Very young or elderly