From the Guidelines
The best diagnostic tool for an upper back injury is typically magnetic resonance imaging (MRI), which provides detailed images of soft tissues including muscles, ligaments, discs, and nerves. For initial assessment, a healthcare provider would likely begin with a thorough physical examination and medical history, followed by X-rays to rule out fractures or alignment issues, as suggested by the American College of Radiology Appropriateness Criteria for suspected spine trauma 1. If symptoms persist or are severe, an MRI would be recommended as it offers superior visualization of soft tissue injuries that X-rays cannot detect.
Some key points to consider when diagnosing upper back injuries include:
- The goal of imaging is to identify potential actionable pain generators that could be targeted for medical treatment, intervention, or surgery 1.
- Thoracic myelopathy is most commonly due to compressive etiologies, including structural causes resulting in spinal canal stenosis, cord compression/deformity, or other inflammatory, infectious, vascular, or neoplastic etiologies 1.
- Symptomatic thoracic disc herniations are more common in patients in their third to fifth decades of life and, in more than one-third of patients, are associated with a history of trauma 1.
- Indication for surgery is usually severe, intractable pain, or progressive/severe myelopathy 1.
In some cases, computed tomography (CT) scans may be used, particularly when bone injuries are suspected. For nerve-related symptoms, electromyography (EMG) might be employed to assess nerve function. The choice of diagnostic tool ultimately depends on the suspected nature of the injury, with MRI being preferred for comprehensive evaluation of most upper back injuries due to its ability to detect subtle tissue damage, inflammation, and disc problems without radiation exposure, as recommended by the most recent study on the topic 1. Prompt diagnosis is essential for developing an appropriate treatment plan and preventing chronic pain or further injury.
From the Research
Diagnosis Tools for Upper Back Injury
- The best diagnosis tool for upper back injury is not explicitly stated in the provided studies, as they primarily focus on low back pain. However, some studies suggest that a combination of patient history, physical examination, and diagnostic testing can be effective in diagnosing back pain 2, 3, 4.
- Electromyography (EMG) and Nerve Conduction Study (NCS) tests can be useful in diagnosing nerve damage and identifying the underlying cause of back pain 5, 6.
- A biopsychosocial approach to back pain, which considers physical, psychological, and social factors, can provide a comprehensive framework for diagnosis and treatment 2.
Diagnostic Testing
- Imaging tests, such as X-rays or MRIs, may be indicated if serious pathology is suspected or if pain persists for more than 6 weeks 2, 4.
- EMG/NCS tests can help identify nerve damage and inform clinical decision-making, with studies showing that these tests can change diagnosis and management in a significant proportion of patients 6.
- Patient history and physical examination are essential components of diagnosis, and can help identify red flags and radicular syndrome 4.
Clinical Decision-Making
- Clinical practice guidelines recommend a multidisciplinary approach to diagnosis and treatment, including reassurance, advice on returning to normal activities, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods 4.
- Referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy, or if there is no improvement after 4 weeks 4.
- EMG/NCS tests can have a significant impact on clinical decision-making, with studies showing that they can change diagnosis and management in a significant proportion of patients 6.