Metastatic disease masquerading as mechanical LBP; atypical symptoms which may rise suspicion

(Finucane, 2013)

Aims: This case reports highlights the importance of early diagnosis of metastatic disease, and identifies symptoms that may help to raise the index of suspicion for the clinician.

Methods: Case report

Results: Patient presentation :

Band like pain / Abdominal pain / Numbness non dermatomal / Vague leg pain / Night waking pain / Intermittent pain / Agg by walking sitting standing, eased by supine lying / Tramadol relieved / no CES symptoms. History of breast K, weight loss 3 kg in 3 months, failed conservative treatment. Previous episodes of LBP but not same sy / no resting pain / limited spinal extension and flexion reproducing LBP but no other / SLR=50° bilaterally and reproduced back pain. Femoral nerve tension test was negative and sensation, power and reflex testing was normal. Babinski and clonus tests were negative

Limitations: Low level of evidence

In Practice: Red Flags = History of cancer, failed conservative treatment, weight loss, night pain, multi-segment pain, band-like pain and odd-funny feelings in legs. Cancers that produce metastasis BLP (LBP) Breast Lung Prostate. Pain can be intermittent and respond to NSAIDs then progress to become worse and unremitting. The pain can radiate into the abdomen or chest and is often described as sharp, shooting deep and band-like. Pain symptoms can be aggravated by lying supine and there is often night pain. The patient may complain of bilateral leg pain. Funny, strange, odd vague feelings in leg can exist.

Finucane, L. (2013). Metastatic disease masquerading as mechanical low back pain; atypical symptoms which may raise suspicion. Manual Therapy, 18(6), 624–627.

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