One of the concerns we have as clinicians—one that patients also have—is a serious diagnosis when they present with an MSK issue. The Society for Vascular Surgery published guidelines in January of 2018 for care of patients with AAA (3). The chances of encountering AAA are pretty slim, so I consider this one of the one-percenters. The majority of lumbar pain does not have a serious origin, but on average 1% do, and AAA is a life threatening diagnosis, which results in death of 9,000 individuals a year in the USA (2). Here are some basic facts about AAA:
- Most common in 65-year-old patients or older.
- It is found in 4% - 8% of older men and 0.5% - 1.5% of older women.
- The largest risk factor is smoking. Other risk factors include heredity, sex, and hypertension.
Ultrasound is most commonly used to diagnose this condition, but if you have a patient enter the clinic with any of the above criteria and/or back pain which is not reproduced by movement it is important to screen for this. Palpation of the aortic pulse has been found to have a sensitivity of 68% and specificity of 75% compared to ultrasound (in finding a pulse width of greater than 3 cm) (1).
The following video is taken during one of NAIOMTs C-511 Lumbopelvic Spine I classes and demonstrates how to effectively palpate the aortic pulse.
References and Resources:
- The accuracy of physical examination to detect abdominal aortic aneurysm
- USCC Clinics Protocol
- Society for Vascular Surgery Practice Guidelines (2018)
Upcoming C-511 Lumbopelvic Spine I courses
Follow the links below for course details and to register:
- November 9, 2019 in Chicago, IL
- November 16, 2019 in Dallas, TX
- November 23, 2019 in Baltimore, MD
- January 18, 2020 in Annville, PA
- January 25, 2020 in Wilmington, NC
- February 7, 2020 in San Diego, CA
- March 13, 2020 in Boston, MA
- March 14, 2020 in Portland, OR
- March 21, 2020 in Falls Church, VA
- April 3, 2020 in Portland, ME
- May 17, 2020 in Orlando, FL
- May 31, 2020 in New York, NY
- September 12, 2020 in Portland, OR
- September 12, 2020 in Boston, MA
- September 27, 2020 in Denver, CO
- November 7, 2020 in Chicago, IL
- November 14, 2020 in Baltimore, MD