Differential Diagnosis for Severe Upper Back Pain
Single Most Likely Diagnosis
- Musculoskeletal strain: The patient's symptoms of severe upper back pain starting after a 10-hour car ride, described as sharp with a wrapping sensation, and exacerbated by inhalation, are consistent with a musculoskeletal strain. The minimal relief with ibuprofen does not rule out this diagnosis, as NSAIDs may not always provide complete relief for musculoskeletal pain.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum could cause sharp chest pain that worsens with deep breathing, consistent with the patient's symptoms.
- Intercostal muscle strain: Similar to musculoskeletal strain, but specifically involving the muscles between the ribs, which could cause pain exacerbated by inhalation.
- Rib fracture: Although less likely without a history of trauma, a stress fracture from prolonged poor posture during the car ride could be considered, especially if the pain is localized to a specific area.
Do Not Miss Diagnoses
- Pulmonary embolism (PE): Although the patient's symptoms do not strongly suggest PE, it is a potentially life-threatening condition that must be considered, especially if there are risk factors such as prolonged immobilization (e.g., the 10-hour car ride).
- Aortic dissection: Severe, tearing chest pain that radiates to the back could indicate an aortic dissection, a medical emergency. The wrapping sensation described could be consistent with this, although the onset after a car ride is less typical.
- Pneumothorax: Sudden onset of sharp chest pain that worsens with inhalation could indicate a pneumothorax, which is a medical emergency.
Rare Diagnoses
- Thoracic spine fracture: Without significant trauma, this would be less likely, but osteoporotic fractures can occur with minimal trauma in susceptible individuals.
- Referred pain from abdominal pathology: Conditions like pancreatitis or a perforated ulcer can refer pain to the back, but these would typically be accompanied by other symptoms such as abdominal pain, nausea, or vomiting.
- Herpes zoster (shingles): Could cause severe back pain, but typically would be accompanied by a rash, which has not been mentioned.