Localization of upper back pain
Back pain is now one of the most common complaints that leads patients to the doctor. Almost every person over 20 years of age has had stronger or weaker back pain at some point in their life. Most causes of back pain of the upper back are harmless.However, it is also very important to consider and treat dangerous courses of back pain and their causes.
Pain that starts in the area of the upper back in the left-hand side of the spine usually has nothing to do with the disc. On the side of the spine are strong muscle strands that are responsible for the stability of the spine and movement. The most common cause of back pain of the upper back on the left side is muscular tension or strains.
It is also called myogelosis. The pain can occur during movement or even at rest, it can continue from the left side via the middle to the right side. Muscular tension does not usually cause neurological deficits, such as radiating into the arms or legs.
Such neurological abnormalities would then fit in with a possible herniated disc, which usually leaves a centrally directed pain. However, a kidney problem in the area of the upper left back should always be considered and excluded. Kidney stones but also so-called inflammation of the renal pelvis can lead to left-sided, stabbing or pressing pain in the area of the upper back.
The examiner taps on the painful area, has the patient do appropriate bending exercises (trunk and side bends) to see how flexible the spine is. If there is any doubt as to whether it is a spinal problem or a kidney problem, an ultrasound examination of the back should be carried out on the one hand, and a urine test on the other, which would provide indications of abnormalities in the area of kidney excretion. Pain in the upper section of the right back is just as common as the left-directed complaints.
Here, too, it is mostly due to muscular hardening that the affected person reports moderate to severe pain in the area of the right side at rest but also during movement. During the examination of the patient, the extent to which his spine is mobile and where there are restrictions should also be checked first. For this purpose, the orthopedist will have the patient perform movements in the area of the spinal column, consisting mainly of forward flexion, backward flexion and lateral flexion.
Furthermore, the examiner will also palpate the patient’s right back to determine if this area is particularly painful and sensitive. If this is the case, one should also think of a disease of the kidneys, which are located at this height on both the left and right sides of the spine. If there is fever, nausea and vomiting in addition to the back pain, one should also think of inflammation of the renal pelvis.
A strong weakness accompanying the back pain also points to kidney involvement. To exclude kidney involvement, an ultrasound examination of the kidneys and a urine test should be performed in any case. Back pain of the upper back is also frequently described, which is mainly localized in the middle.
It is very important to find out when the pain started, whether the pain radiates, if so, where, and whether the pain occurs at rest or during movement. Finally, it should also be found out whether there are any neurological abnormalities, i.e. whether the patient reports pain radiating into arms or legs. This could also indicate a herniated disc, which would then have to be diagnosed using imaging techniques (MRT or CT).
Even if the patient states that he feels numbness or tingling in his arms or legs, a herniated disc must be considered. The middle part of the upper back can also be affected by muscle tension and can lead to severe discomfort in this area. Sometimes an inflammation can also occur in the area of the vertebral bodies.
This is also known as spondylodiscitis, which is not without danger and requires urgent treatment. An inflammation of the vertebral body can spread untreated and lead to further serious courses. In this context, an x-ray provides decisive information as to whether the inflammation of the vertebral bodies is involved. If it is such an inflammation, anti-inflammatory and antibiotic treatment must be started immediately, sometimes even on an inpatient basis.
