Spinal cord compression
Intro
Abdominal pain may be resultant from compression of the spinal cord or nerve roots. Compression of the cord or roots my be present from tumors, either primary or metastasized, disc herniation or skeletal compression. Pain may present as a deep, dull, aching discomfort that is non-localized or a sharp burning pain from the dorsal root. Pain may refer unilaterally or bilaterally into the lower abdomen or legs depending on the severity and variation of the compression.
S&S
Disc herniation in the thoracic area may often imitate those of a spinal cord tumor. Indications for the presence of a tumor include pain at night, pain when lying down and the presence of painless neurologic deficit. Groin pain will present both disc herniation and spinal cord tumor, however groin pain severity will be much greater in the presence of a spinal cord tumor. Autonomic symptoms of sweating, nausea and tachycardia may be present with non-musculoskeletal or musculoskeletal structure involvement as well. Non-musculoskeletal pain may be of visceral origin with deep cramping and aching of the abdomen. Spinal dysfunction of the thoracic area refers to the abdomen and chest wall. Spinal referred pain will present with movement and is associated with muscle tightness and tenderness. Muscle tightness or structural compression will be found at the spinal level supplying the area of pain. Skeletal involvement of abdominal pain may also include slipped or fractured ribs, misalignment of skeletal structures or pelvic structure involvement. Spinal compression fractures may result form associated diseases, such as osteoporosis, leading to cord impingement.
Referral patterns
· Disc herniation and spinal cord tumor will refer pain to the groin
· Thoracic spinal dysfunction refers to the abdomen or chest wall
· Rib involvement may refer pain to the abdomen
Rule in or Rule out
· Screen for presence of systemic signs and symptoms
· Pain with movement indicates musculoskeletal origin
· Decreased sensation, muscle weakness, atrophy or bowel and bladder symptoms suggest spinal cord tumor
· Increased groin pain severity will be much greater in the presence of a spinal cord tumor
· Absence of symptoms with movement is suggestive of a non-musculoskeletal cause
· A positive response to therapy will support, but not prove the presence of musculoskeletal referred pain.
· Differential diagnosis for level T12-L1 for males with testing of the Cremasteric reflex
· Presence of hip pain may indicate spinal metastases to the femur or lower pelvis
Special Tests
· The Cremasteric Reflex
Abdominal pain may be resultant from compression of the spinal cord or nerve roots. Compression of the cord or roots my be present from tumors, either primary or metastasized, disc herniation or skeletal compression. Pain may present as a deep, dull, aching discomfort that is non-localized or a sharp burning pain from the dorsal root. Pain may refer unilaterally or bilaterally into the lower abdomen or legs depending on the severity and variation of the compression.
S&S
Disc herniation in the thoracic area may often imitate those of a spinal cord tumor. Indications for the presence of a tumor include pain at night, pain when lying down and the presence of painless neurologic deficit. Groin pain will present both disc herniation and spinal cord tumor, however groin pain severity will be much greater in the presence of a spinal cord tumor. Autonomic symptoms of sweating, nausea and tachycardia may be present with non-musculoskeletal or musculoskeletal structure involvement as well. Non-musculoskeletal pain may be of visceral origin with deep cramping and aching of the abdomen. Spinal dysfunction of the thoracic area refers to the abdomen and chest wall. Spinal referred pain will present with movement and is associated with muscle tightness and tenderness. Muscle tightness or structural compression will be found at the spinal level supplying the area of pain. Skeletal involvement of abdominal pain may also include slipped or fractured ribs, misalignment of skeletal structures or pelvic structure involvement. Spinal compression fractures may result form associated diseases, such as osteoporosis, leading to cord impingement.
Referral patterns
· Disc herniation and spinal cord tumor will refer pain to the groin
· Thoracic spinal dysfunction refers to the abdomen or chest wall
· Rib involvement may refer pain to the abdomen
Rule in or Rule out
· Screen for presence of systemic signs and symptoms
· Pain with movement indicates musculoskeletal origin
· Decreased sensation, muscle weakness, atrophy or bowel and bladder symptoms suggest spinal cord tumor
· Increased groin pain severity will be much greater in the presence of a spinal cord tumor
· Absence of symptoms with movement is suggestive of a non-musculoskeletal cause
· A positive response to therapy will support, but not prove the presence of musculoskeletal referred pain.
· Differential diagnosis for level T12-L1 for males with testing of the Cremasteric reflex
· Presence of hip pain may indicate spinal metastases to the femur or lower pelvis
Special Tests
· The Cremasteric Reflex
References:
Goodman, MBA, PT, C. C., & Snyder, MN, RN, OCN, T. E. (2007). Differential Diagnosis PHYSICAL THERAPISTS Screening for Referral (4thth ed.). St. Louis, MO: Saunders Elsevier
Kogos Jr.,PhD, S. C., Richards, PhD, J., Ban˜os, PhD, J. H., Ness, MD, PhD, T. J., Charlifue, PhD, S. W., Whiteneck, PhD, G. G., & Lammertse, MD, D. P. (2005). CLINICAL NOTES Visceral Pain and Life Quality in Persons With Spinal Cord Injury: A Brief Report. The Journal of Spinal Cord MEdicine, 28(4), 333-338. Retrieved June 25, 2013, from PubMed.
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