Diagnostic Tests for Lower, Middle and Upper Back Pain
When your back hurts, whether the pain arises in the lower, middle or upper region, all you likely care about is figuring out the cause and getting relief.
Fortunately, a variety of proven diagnostic tests for back pain can often pinpoint the trigger, helping smooth the path toward effective back pain treatment, according to Kaixuan Liu, MD, Ph.D., founder of Atlantic Spine Center.
Certain elements of back pain are universal no matter which part of the spine hurts, Dr. Liu says. But diagnostic tests may vary somewhat depending on whether your pain is in the lower, middle, or upper region. That is because the causes of middle or upper back pain are sometimes quite different than problems that strike the lower back.
Lower back pain is exceedingly prevalent, with most adults in the United States suffering from it at some point in their lives, according to the National Institutes of Health. But middle and upper back pain is not as common for a very good reason. The bony vertebrae in those regions, between the neck and the bottom of the ribcage, do not flex as much as vertebrae at the top and bottom ends of the spine, which enable us to move our heads and hips.
“Because the upper back area encompasses the torso and houses key organs such as the heart and lungs, back pain in this area also has a higher chance of stemming from a more serious condition,” Dr. Liu explains.
“Pain in the upper or middle back can also be vague since it might be ‘referred’ to that area from another part of the upper body,” he adds. “Because of that, doctors may need to dig deeper with diagnostic tests to determine the true cause of back pain.”
Stepwise approach
Regardless of what area of your back hurts, getting to the bottom of it typically starts with a list of questions from your doctor. This helps your physician with collecting your medical history to rule out other conditions.
You will likely be expected to answer:
- When the pain started
- What you were doing when it began – such as lifting a heavy object
- What makes the pain better or worse
- If you’ve had the pain previously
- If you’ve suffered any recent illnesses, including stomach bugs, urinary problems or pelvic pain
- If you have any relatives with similar symptoms or potentially relevant conditions
Physical exam
Once your doctor takes a comprehensive medical history, they will proceed to give you a thorough physical exam, Dr. Liu says. This workup typically includes:
- Watching you walk on your heels, toes, and soles of your feet to look for signs of nerve damage
- Testing your reflexes with a reflex hammer at your knees and ankles
- Testing nerve and muscle strength by asking you to raise your legs while lying down
- Assessing sensation in your legs using a sharp object
- An abdominal, pelvic or rectal examination, depending on specific symptoms, to look for diseases that can trigger back pain with nerve damage.
There are two types of inspection during a physical exam: a visual and a hands-on inspection. The first one is used to check the posture and the skin. The second one is used to determine tenderness or spasms. There are also a number of motion tests to check the mobility of the joints, which are also tested during a segmental examination.
Neurological exam
Usually, after a physical exam, your doctor will have to complete a neurological exam.
This exam is performed to test your hearing, vision, strength, balance, or coordination, as well as other neurological functions and reflexes. Generally, at this stage, the doctor tests reflexes, strength, and other nerve changes, including checking if the pain radiates into other body parts. The goal of this exam is to understand whether the spinal nerves are affected.
Back pain imaging tests
Most back pain resolves on its own within 4 to 6 weeks, according to Dr. Liu. For that reason, imaging tests might not be done immediately – unless acute pain in your back signals problems such as major trauma or a condition that threatens nerve damage.
When your doctor decides to “peek inside” to see what’s causing your upper, middle or lower back pain, what diagnostic tests are used? Dr. Liu says they include: X-rays: This old standby is limited in distinguishing causes of back pain, Dr. Liu notes, but may be useful to determine conditions such as the bone-thinning disease osteoporosis or various traumatic injuries.
Myelogram: This type of X-ray involves injecting a special dye into the spinal canal.
MRI: Using magnets to produce images, this diagnostic test can pinpoint certain serious problems around the spine, including infections, tumors, or fractures. CT: Computerized tomography, or CT, scans can show soft tissue problems such as ruptured discs, narrowing of the spinal canal, or tumors.
Electrodiagnostic testing involves two tests: nerve conduction study, which we’ll cover later, and electromyography. Electromyography determines the electrical activity in a muscle, which helps determine weaker muscles.
Aside from imaging tests, your doctor may also perform nerve conduction studies, which use electrodes to both stimulate nerves running to muscles and record the nerve’s electrical signals. Nerve conduction studies can detect nerve damage.
“If you’ve experienced lasting pain in your upper, middle, or lower back, rest assured your doctor has plenty of diagnostic tests at their disposal to unearth the cause,” Dr. Liu says.
Diagnostic injections
Diagnostic injections are used to find the location of the pain source. This injection is performed with local anesthesia and using a special contrast dye to better visualize the needle.
There are several types of diagnostic injections, such as facet joint injection, which targets the facet joint to test as well as provide relief. During a medial branch block, lidocaine is injected into a nerve. This procedure is only used for tests, as it doesn’t relieve pain. Another procedure, selective nerve root block, also targets nerves, but this time it’s the root. By injecting anesthetics or corticosteroids into the root, the pain can be eased.
