Examination reveals stiff spine, normal straight leg raising, normal peripheral pulses and no radicular signs until late. CT is the study of choice. Postural back pain is perhaps the commonest cause of persistent back pain. Postural problems include flat lordosis, exaggerated lordosis and scoliosis. Causes include poor seating or bedding, household tasks that require much bending, high heeled shoes, and unequal leg length.
Treatment includes heel lifts and correction of bad postural habits.
Aspirate the affected joint or bursa. If you are unsure of the anatomy or are uncomfortable with this procedure, request a rheumatology consultation. Send fluid for Gram stain, culture and sensitivity, WBC count, and for examination for presence of crystals. Synovial fluid glucose is useful but only if a simultaneous blood glucose is obtained. If fluid cannot be obtained and there is a strong suspicion of septic arthritis or bursitis, the patient should be admitted for further work up.