Middle Back Pain – Investigations

Investigations into the cause of a disease are important tools in initiating treatment. Common diseases have specific tests, the results of which give confirmation of the presence of the disease. However, many times the picture is quite confusing and requires a battery of investigations. A proper choice of investigations can save time and money, which can be then utilized for the treatment. So let us take a look at the methods of reaching an accurate diagnosis in middle back pain.

Clinical tests for Middle Back Pain

A clinical examination by an orthopedist is the only thing that is needed for superficially visible diseases, like deformities, etc. The deformities can be graded as structural or postural. This can be distinguished by the forward bending test, in which if the deformity disappears on forward bending then it is postural and vice-versa. The forward bending resets the muscular imbalances by stretching the muscles completely. Thus, if a deformity is persistent after forward bending, it is bound to be due to a defect in the vertebral column.

The examination of the posture and gait of an individual also give clues regarding the diagnosis. Clumsiness in gait and posture is the first sign of an impending paralysis of legs. The presence of sharp pain on palpation of a vertebra can be due to a tumor or infection of the vertebra. The reproduction of middle back pain during movements like forward bending or sideways bending indicates involvement of 2-3 adjacent vertebrae. The pain is felt during the normal gliding movement between each other.

Laboratory tests for Middle Back Pain

  • Erythrocyte sedimentation rate (ESR) – which is raised in tuberculosis, tumors, etc.
  • Mantoux test – gives confirmation of tuberculosis infection.
  • Serum calcium, phosphorus, and alkaline phosphatase – are raised in tumors.
  • Urine test – contains Bence Jones proteins for diagnosis of multiple myeloma (spinal tumor).
  • Pulmonary function tests (PFT) – to check if spinal deformity is causing any compromise of lung function or if patient has breathing difficulties.

Radiological tests for Middle Back Pain

  • X-ray of the spine – has specific features which help to identify and distinguish between tumors, infections, and deformities. However, a normal x-ray does not always mean an absence of disease and so other tests have to be used for diagnosis.
  • MRI – is expensive but clearly gives the diagnosis. It is also needed for planning of the surgery as it gives the exact location of the disease.
  • Bone scan – is specifically for diagnosis of early tumors and infections which are not seen on x-ray or MRI.

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About Dr Gauresh (69 Articles)
An orthopedic surgeon trained in JJ Group of Hospitals and Grant Medical College. I have worked in this field for the past 3 years and have significant clinical experience to guide students and patients on any topic in orthopedics.

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