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Exams and Tests to Diagnose Upper Back Pain

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Upper back pain can become so severe that it limits your daily life. If it gets to that point, or if your pain lasts more than a week, you should make an appointment to see a doctor.

During your visit, the doctor will ask you basic questions and perform some exams. All that will help him or her diagnose the cause of your upper back pain and develop a treatment plan for you—a way to manage your pain and other symptoms and heal your body.

Questions to Help the Doctor Understand Your Upper Back Pain
The doctor will probably ask you questions such as:

  • When did you first notice the pain?
  • Does the pain seem to travel from your upper back to any other part of your body?
  • Have you noticed other symptoms besides pain?
  • What activities did you recently do?
  • What have you done to treat your upper back pain?
  • Does anything reduce the pain or make it worse?

Physical Exam
The doctor will also do a physical exam. In that exam, your doctor will observe your posture, range of motion (how well and how far you can move certain joints), and physical condition, noting any movement that causes you pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasms and tenderness. Upper back pain is often caused by muscle problems, so a thorough physical exam is important.

Neurological Exam
You may also have a neurological exam. The doctor will test your reflexes, muscle strength, other nerve changes, and pain spread (that is—does your pain travel from your back and into other parts of your body?). The neurological exam checks to see if your spinal nerves have been affected.

Imaging Tests
You may have to have imaging tests done if the doctor suspects that your upper back pain is caused by a mechanical problem in the thoracic spine (as opposed to a muscle problem such as a strain).

You may have an x-ray, which can help your doctor "see" the bones in your spine. X-rays are effective at showing vertebral fractures or osteoarthritis.

A Computerized Axial Tomography scan (a CT or CAT scan) is the best imaging test to show the bones and joints.

If your doctor thinks there is a nerve problem, you may have to have another test called a Magnetic Resonance Imaging test (an MRI) performed. The pictures produced by an MRI machine are very detailed, so the doctor can see all of the structures in your spine. On an MRI, the discs show up better than on a CT scan.

Other Possible Tests
Osteoporosis is a possible cause of upper back pain, so if your doctor suspects that you have that bone-weakening condition, he or she may have you do a bone mineral density (BMD) test. It will help the doctor understand how strong and healthy your bones are. For more information on how a BMD test helps doctor diagnose osteoporosis, read the article Exams and Tests for Osteoporosis.

Diagnosis
Through the physical and neurological exams—and with any needed imaging tests—the doctor should be able to diagnose the cause of your upper back pain and get you on your way to feeling better.

Updated on: 11/13/12
Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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