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Low back Pain VINDICATE.

Adapted from Collins RD (2003) Differential Diagnosis in Primary Care. Lipponcott Williams & Wilkins (3 rd Ed). Table 45.

Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
/ infection & Deficiency & intoxication Acquired Allergic
anomaly

Skin Herpes zoster Malignant Pilonidal cyst Psoriasis Contusion.


melanoma. Laceration.

Muscle and Fibromyositis, Herniation of Contusion.


fascia and trichinosis subfascial fat. Tear.
ligaments Postural Sprain.
factors. Psoas spasm

Lumbo sacral Osteochrondritis Tuberculosis, Hodgkin Osteomalacia, Pagets disease. Disc bulge/ Rheumatoid Disc bulge. Osteitis fibrosa
spine Osteomyelitis. disease, Osteoporosis, Alkaptonuria. herniation / spondylitis. Nuclear Cystica.
Facet capsulitis. Metastatic Osteoarthritis, Gout. sequestration Ankylosing sequestration.
Facet lock. carcinoma, Lumbar Lumbarisation spondylitis. Anular strain. Osteomalacia
Radiculitis. Multiple spondylosis. Sacralisation Sero negative Fracture Hyper-Adrenal
myeloma. Spondylarthrosis Spinabifida. arthropathies. Sprung back. Cushings
Meniscoid Spondylysis Spondylolisthesi Reiters Coccydynia osteoporosis.
locking Secondary from s. Crohns
breast, lung, GIT, Coccydynia. Ulcerative colitis Hyperthyroidism
kidney, prostate. Scoliosis. SLE. osteoporosis.
Hemivertebra
Pagets (Sacroiliitis)
Hypermobility

Spinal cord Atrioventricular Epidural Primary and Spinal stenosis Piriformis


and cauda anomaly abscess. metastatic Cauda equina syndrome
equina Meningitis tumours NRI

Aorta Aortic aneurysm Dissecting


aneurysm

Rectum and Haemorrhoid Anal fissure, Carcinoma Visceroptosis


GI Peri-rectal
abscess

Uterus, tubes Endometriosis, Fibroid, Dysmenorrhea


& ovaries Ovarian Carcinoma,
abscess Endometriosis, Soft tissue
Ovarian cyst damage in child
birth.
Bladder and Cystitis, Prostatic Renal calculi Ruptured
prostate, Urethritis, hypertrophy. bladder or
kidney Prostatitis Carcinoma. urethra
Thoracic Spine Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
/ infection & Deficiency & intoxication Acquired Allergic
anomaly

Bone Calves disease TB (ant vertebral Hodgkin disease, Pectus carinatum. Rib fracture Osteoporosis
body) Metastatic Pectus excavatum Vertebral fracture
Vertebra and
Osteochondritis carcinoma,
rib Scheurmanns Tietzes syndrome Multiple myeloma. Kypho-scoliosis.

Secondary from
breast, lung, GIT,
kidney, prostate.
Disc Spondyolosis
Disc bulge /
prolapse.
Cartilage Osteo-arthritis
Capsule Rib lesion RA,
Facet lock AS ,
Psoriatic
Reiters
Enteropathic
Crohns
Whipples
UC
SLE
Ligaments Strain spinal,
costo/vertebral,
and costo/
transverse joint.
Muscles PAN Hiatus hernia Scapulo/ thoracic Diaphragm Strain
DISH dysfunction.
Nerves T4 syndrome Spinal stenosis Intercostal nerve Myaesthenia cord compression
Herpez zoster and cord compression gravis
compression
Viscera Aortic aneurysm, Kidney (T/L, Apical Renal calculi, Asthma Pneumothorax Hyperthyroidism
Cor pulmonalae, L1/2) carcinoma. gallbladder Hyper-ventilation - angina
MI, Referred pain
Endocarditis, from heart, lung Oesophageal Mastitis
Rheumatic fever. bronchiltis, lesion.
Buergers empyema, Hypothyroidism
disease COPD, pleuricy, diaphragmatic
pneumonia,abd pain
DVT / embolism. ominal viscera;
gall baldder, GI
ulcer, peritonitis,
bowel, spleen,
pancreatitis.
Cervical Spine Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
/ infection & Deficiency & intoxication Acquired Allergic
anomaly

Bone TB Hodgkin Stenosis Klippelfeil Dens fracture*** Osteoporosis


disease, Cervical rib Spondylolisthesis
Metastatic Spondylolysis
carcinoma, Elevated
Multiple scapula
myeloma.
Turners syndrome
Secondary from
breast, lung, GIT, Beurgers
kidney, prostate. syndrome

Disc Prolapsed disc,


Disc bulge.
Cartilage OA
Capsule Facet lock / RA,
apophysitis AS ,
Psoriatic
Reiters
Enteropathic
Crohns
Whipples
UC
SLE
Ligaments Hypermobility** RA Whiplash
Marfans. Strain
Muscles PAN Torticollis Scalene
PMR TMJ hypertonia.
dysfunction
Nerves TOS Brachial Cervical bar / MND Myaesthenia CN VII, XI, XII
CVA plexus myelopathy. gravis
TIA
VBI Meningitis***
Embolism
Raynauds

Viscera Cardiac angina Shoulder, To cervical


ENT, lymph nodes.
thyroiditis,
oesophagitis
Shoulder Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
/ Infection & Deficiency & intoxication Acquired Allergic
anomaly

Bone Osteomyelitis Metastases/ Klippel Feil Fracture neck of


Apical tumour. syndrome. humerus, greater
Leukaemia Sprengels tuberosity,
shoulder. clavicle, scapula.
Cervical rib
Cartilage / Primary and SLAP
labrum secondary OA of
GH, AC.
Capsule Haemarthrosis Transient RA Dislocation, Diabetic or
/ligament synovitis, Adhesive subluxationGH, hyperthyroid
Septic (acute capsulitis AC, SC. adhesive
pyogenic) AS , capsulitis.
arthritis **** Psoriatic
TB Reiters
Enteropathic
Crohns
Whipples
UC
SLE
Subacromial Bursitis
bursa Painful arc
Muscle / Haematoma Biceps or rotator Calcification in PMR Tendon rupture
tendon cuff tendinitis rotator cuff PAN (long head
Calcification in painful arc biceps and
tendons rotator cuff)
Impingement
(painful arc)
Nerve TOS Cervical Supra/ infra Brown Sequard
radiculopathy spinatus
neuropathic
C5 amyotrophy from
XI suprascapular
nerve damage in
notch.
MND
Cervical spine Referred pain
Viscera Cardiac Lungs, kidney,
ischaemia spleen, gall
bladder
diaphragm
(C3/4/5
sensitisation)
Hip Pain VINDICATE.
Students Team 1 and 3 Summer 2010

Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
/ Infection & Deficiency & intoxication Acquired Allergic
anomaly

Bone Avascular Osteomyelitis Primary or Osteomalacia Congenital Fracture femur, Osteoporosis


necrosis, secondary. dislocation of pelvis
Perthes TB Leukaemia. hip.
disease Multiple Coxa valgua
Slipped femoral myeloma
epipysis Pagets
(sequestrosom
e 1 gene on
chromosome
5)

Ottos pelvis
Capsule/ Transient RA, Strain Pregnancy
ligament synovitis, AS, Dislocation hip, ligamentous
Septic (acute Psoriatic Snapping hip, laxity.
pyogenic) Reiters Clicking hip
arthritis **** Enteropathic
TB Crohns
Whipples
UC
SLE
Cartilage / Primary or CDH Labral tear or
labrum secondary OA impingement
Trochanteric bursitis
bursa
Muscle / Psoas PMR ITB friction
tendon shortening PAN syndrome
(Tyler 2010).
Piriformis
syndrome.
Inguinal hernia.
Nerve Radiculopathy MS Meralgia
L2 -5NR paraesthetica
Viscera Appendicitis Femoral hernia
Pelvic
inflammatory
disease.
Sacro-iliac Referred pain pubic
joint symphysis
Knee Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
/ Infection & Deficiency & Acquired Allergic
intoxication anomaly
Bone Avascular necrosis Osteomyelitis Metastases. Rickets Pagets Fracture Osteoporosis
Osteosarcoma. Osteomalacia Patella alta Patella
leukaemia Genu varum / valgum Fibular (Bumper
Osgood Schlatters fracture)
Tibia (& end plate)
Femur
Cartilage/ Tabes dorsalis Osteoarthritis primary Loose bodies Meniscal tear Diabetic Charcots
and secondary. joint
menisci
Chondromalacia
patellae.
Ostechondritis
descicans.

Capsule Haemarthrosis**** Transient RA, Gout


synovitis, AS , psoriatic
Septic (acute Reiters
pyogenic) arthritis Enteropathic
**** Crohns
TB Whipples
UC
SLE
Ligament Pellegrini Stieda Hypermobility (Ehlers Strain / tear MCL,
(calcification of MCL) Danlos, Marfans) LcL, coronary,
ACL, PCL,
dislocation of
patella or
femoral/tibial jnts.
Bursa Supra, infra, Bakers cyst Bakers cyst
prepatellar bursitis (semimembranosis (semimembranosis
bursa) in RA. bursa)
Muscle / PAN Psoas abcess Jumpers knee Patellar Rupture / tear. Diabetic
(superior pole of tracking Torn infra patellar amyotrophy
tendon
Haematoma patella). Q angle lig
Runners knee (ITB) Sindig-Johansson
Intermittent Larson disease
claudication (traction to inf pole
of patellar lig)
Nerve Stroke Polio. Syphilitis Parkinsons MS Peroneal nerve
L3-4 NR pain
Sciatica
Hip Referred pain

Viscera Popliteal
aneurysm****
DVT****
Ankle and Foot Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine /
& & Deficiency & intoxication Acquired Allergic metabolic
Infection & iatrogenic anomaly

Bone Avascular Osteomyelitis Osteosarcoma Osteophytes Thalidomide Fracture; Acromegaly


necrosis. Claw toe Potts (spiral
Osteochondrosis Sesamoiditis Hammer toe fracture distal
Severs Talipes equino tibia and fibula)
(calcanium in varus
children) Kohlers
(navicular age 5)
Calcaneal spur.
Capsule / Haemarthrosis Transient Dropped Hypermobility RA, Strain, subluxation, Gout
synovitis, AS , psoriatic dislocation.
ligament / cuboid (Ehlers
Septic (acute Reiters Retinacular strain.
retinaculum pyogenic) arthritis Danlos, Enteropathic Inversion /
**** Marfans) Crohns eversion strains
TB Whipples
Reiters UC
SLE
Fascia Plantar fasciitis
Cartilage Osteoarthritis
primary and
secondary
Muscle / tendon Varicose veins. ganglion Dropped Achilles rupture Diabetic
DVT, pitting transverse arch, *** gangreen
oedema, poor pes planus
calf pump. (medial
Intermittent longitudinal
claudication arch).
Nerve Anterior, lateral Tabes dorsalis Plantar neuroma Radiculopathy. Post surgery Metatarsalgia MS Mortons Peripheral
compartment Charots joints. Complex -complex neuralgia. neuropathy.
syndrome*** Polio regional pain regional pain Proprioceptive Diabetic
syndrome syndrome. loss with Charcots joint.
Stroke (Sudecks ligament
atrophy / reflex damage.
sympathetic
dystrophy)
Lymph Lymphangitis
Viscera Right sided heart
failure
Lumbar spine Referred pain. Referred pain. Fracture Peripheral
Neuropathy NR pain. neuropathy
L5,S1 foot drop.
Hand and Wrist Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
& & Deficiency & intoxication Acquired Allergic
Infection & iatrogenic anomaly

Bone Avascular Osteomyelitis Osteosarcoma Osteophytes Thalidomide Fracture; Acromegaly


necrosis Web fingers scaphoid.**
(working in Lack of digit
compressed air Radial head.
Hook of hamate.
conditions) Swan neck
Keinbocks fracture of digit.
disease
Capsule / Haemarthrosis Transient Hypermobility RA, Strain, dislocation,
synovitis, AS , psoriatic subluxation (lunate
ligament (Ehlers
Septic (acute Reiters capitate)
pyogenic) arthritis Danlos, Enteropathic Proximal and distal
**** Marfans) Crohns interphalengeal
TB Whipples joints.
Reiters UC Skiers thumb
SLE
Fascia Volkmanns Alcoholic
ischaemic Dupuytrens
contracture contracture
Cartilage Osteoarthritis
primary and
secondary
Muscle / Ganglion Trigger finger RSI
tendon De Quervains. Volkmanns
Ganglion CEO referral.
Tenosynovitis
Nerve TOS Radiculopathy. Post surgery Klumpkes and MS Compression of Carpal tunnel in
Stroke Complex -complex Erbs palsy. ulnar, median pregnancy and
Ischaemic regional pain regional pain (carpal tunnel) hypothyroid.
contracture. syndrome syndrome. and radial nn.
Raynauds (Sudecks Tunnel of Guyon.
atrophy / reflex Peripheral Saturday night
sympathetic neuropathy palsy
dystrophy)
Lymph Lymphangitis NSAI (swelling)
Viscera Liver palms White nails. Alcoholic
Splinter Clubbing Duputryens
haemorrhage Spooning
(infective
endocarditis)
Cervical spine Referred pain Referred pain. Fracture
Cervical bar
(myelopathy)
Elbow Pain VINDICATE.
Students Team 1 and 3 Summer 2010
Vascular Inflammatory Neoplasm Degenerative Idiopathic Congenital & Auto immune Trauma Endocrine
& & Deficiency & intoxication Acquired Allergic
Infection anomaly

Bone Avascular Osteomyelitis Osteosarcoma Osteophytes Thalidomide Fracture; Hyperthyroism


necrosis olecranon,
Benign bone cysts
(working in Increased radial head,
compressed air carrying angle distal humerus
conditions)
Osteochondritis Cubitus valgus/
dessicans varus

Capsule / Haemarthrosis Transient Hypermobility RA, Strain ,


synovitis, AS , psoriatic
ligament (Ehlers dislocation,
Septic (acute Reiters
pyogenic) arthritis Danlos, Enteropathic subluxation
**** Marfans) Crohns radial head
TB Whipples (annular lig).
Reiters UC
Olecranon
SLE
Loose body Gout fossa scar
tissue.
Olecranon Bursitis bursitis
Bursa
Cartilage OA primary
and secondary
Muscle / CEO Lateral Shortening, Myositis
tendon CFO (Tennis)/ post chronic ossificans
medial radiculopathy / (brachialis)
(Golfers) stroke etc.
epicondylitis RSI
Enthesopathy
Boceps
aponeurosis
Nerve TOS Radiculopathy. Compression
Complex of ulnar,
regional pain median
syndrome (pronator
(Sudecks atrophy / teres) and
reflex sympathetic
radial nn.
dystrophy)
Lymph Lymphangitis
Cervical spine Referred pain / Referred pain
NR pain