Trick of the trade: Percuss the spine in low back pain

May 05, 10
Trick of the trade: Percuss the spine in low back pain

 SpineAnatomysmMany patients present to the Emergency Department for low back pain. Determining whether these patients have a red-flag diagnosis can be difficult. Red flag diagnoses include:

  • Fracture
  • Cauda equina syndrome/ spinal cord compression
  • Spinal infection
  • Vertebral malignancy

Almost all patients presenting with back pain, whether it be a muscle spasm or a spinal epidural abscess, will have back tenderness to some extent. So, how can you better differentiate benign from dangerous etiologies?

Trick of the trade

Spine percussion

Percussion is an easy physical exam technique that can be used to risk-stratify patients that you suspect may have serious back pathology. Classically, percussion of the thoracic and lumbar spine should trigger pain in patients with serious back pain pathology, such as vertebral malignancy or a spinal infection. Because bone conducts vibration extremely well, percussion irritates deep space pathology. In contrast, percussion should not exacerbate discogenic pain, back strain, or muscular spasm.

SpinePercussion_sm

Technique

Position your finger over the spinous process, and percuss using your other hand. Repeat this for each vertebral level. With significant focal spine tenderness to percussion, the clinician should be more suspicious for worrisome pathology.

Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

The post Trick of the trade: Percuss the spine in low back pain appeared first on ALiEM.

Leave a Comment

Like articles like this one?

Join our Email List and get the latest TCCC/TECC/TEMS news bulletins, articles, product releases, and more!

Free Delivery

On all orders over $99 within CONUS and to APO/FPO

Easy Returns

We're here to help! Satisfaction Guaranteed

Knowledgeable Staff

Ready to assist you at a moment's notice

Safe& Secure Checkout

World’s most advanced and secure website encryption.