[ender18d]

The point of this case is to illustrate an example of a "red flag." Back pain is an unbelievably common complaint, especially in the military. Most of the time, back pain is a relatively self-limiting condition requiring only some supportive treatment and the tincture of time. However, there are a number of extremely dangerous causes of back pain that can masquerade as lumbago. Obviously, we're not going to go full House MD every time a team-mate has a little back ache, so we need some screening questions to identify those back pain cases that need more thorough investigation. This list is not exhaustive, but it covers some of the most important issues to look out for.

Red Flags: Fever, Night Sweats, Unexplained Weight Loss
Why we're concerned? Infection, Rheumatologic Disease, Cancer

Red Flags: Personal History of Cancer, Constitutional Symptoms, New onset at age > 50 w/o clear mechanism
Why we're concerned? Cancer

Red Flag: Age <18
Why we're concerned? Stress fractures, infection, discitis

Red Flag: Unrelenting nocturnal pain
Why we're concerned? Cancer, osteoid osteoma

Red Flag: History of Trauma
Why we're concerned? Fracture

Red Flag: Numbness or sensation change, neuro findings on PE
Why we're concerned? Nerve root compression

Red Flag: Bowel or bladder incontinence, "saddle" sensation changes
Why we're concerned? Cauda Equina Syndrome

Red Flag: IV drug use, immunosuppressed status (IE corticosteroid use!)
Why we're concerned? Infection

(to be clear, the red flag finding does not diagnose the concern! It is just an important finding that should prompt further investigation)