Brief Answer:
Need more information to give opinion

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.


I can understand your concern. I need to know few details of her complaints

: What part of back - upper or lower? Mostly it is lower. Please specify.

: Is there a history of radiation of pain in leg/thighs?

: Is there any neck pain along with difficulty in right hand movements?

: Any history of chronic illness like Diabetes, hypertension, osteoporosis, spine injury, tuberculosis?

If you can provide some detail of pain and above questions, it would help him in reaching some conclusion. Hope you will understand my point.

Thanks. Take care.

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Brief Answer:
Differential Diagnosis of disease and management

Detailed Answer:
Hi XXXXXXX welcome back.


I got your point. The upper back pain which is non radiating, occurring in 56 years old, postmenopausal female can be

: Muscular pain - It is one of the most common cause of upper back pain. Disc herniation is uncommon in this region. Muscular pain occurs due to prolonged standing, daily household work, low calcium due to poor diet/low oestrogen-progesterone. However it can be confirmed only if her
: pain is dull aching, increases on pressure at pain site/stretching of back
: relief in pain on taking rest/applying painkiller gel/hot fomentation
: no sensory or focal functional deficit

If her symptoms are such that, you should follow few tips to relieve pain
: Ask her to avoid weight lifting like lifting bucket/household objects
: Avoid forward bending work
: Give rest to muscle
: Apply warm/hot fomentation 4-6 times daily.
: Apply painkiller gel like Diclofenac gel 3-4 times daily after proper prescription.
: You can give her Tablet Thiocolchicoside-Diclofenac combination after proper prescription, for 5 days. Then give her only Tab Diclofenac sodium for next 7-14 days depending upon symptomatic relief. Along with it, you must give her Tab Pantoprazole to prevent acidity. It is OTC drug.
: Give her calcium and vitamin D rich diet like dairy products (milk, curd, cheese), eggs, meat.
: Consult physiotherapist for stretching of muscles and strengthening exercise.
: If still no relief, consult orthopaedician for muscle tear.

: Another possibility could be bone pain due to osteoporosis - It occurs due to low calcium and vitamin D which leads to vertebral compression/weakening and later on pain. It can be suspected if pain is exactly in midline, her posture has changed and forward bending has increased, history of fracture with minor injury, more pain on standing/sitting/lifting weight, no radiation.

For it, you need to consult orthopaedician. He will advise
: Blood calcium level
: Vitamin D3 level
: X ray or CT of spine along with MRI spinal cord if any bony deformity.
: Bone densiometery

After confirmation, treatment includes
: Daily calcium tablet intake once or twice a day.
: Vitamin D3 replacement as 60,000IU once a week for 3 months which is what I prescribe.
: Posture correction exercise
: Avoid weight lifting, injury, exertion
: Physiotherapy
; Hormone replacement therapy for oestrogen and progesterone
: Regular follow up till full recovery.

Now coming to hand movement difficulty, can you please specify little more about difficulty in hand movement e.g. what movement is affected more?, what fingers are involved?, Any pain/tingling/numbness over fingers or palm?.
I am suspecting it to be

: Carpel tunnel syndrome - if occurring only in thumb and adjacent two fingers, pain and tingling in whole hand, more symptoms after waking up/keeping hand at low level/extension or flexion at wrist. If her symptoms are such that you should consult neurologist for the diagnosis confirmation and cause
- Osteoporosis
- Hypothyroidism

It is confirmed by
: Examination
: Nerve conduction velocity (NCV) of nerve

If her symptoms are such that, do let me know. I will describe you how to manage it. Sorry I forgot mentioning it in my previous answer.

Hope it will help you. Thanks. Take care.

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Brief Answer:
Cause of pain and management

Detailed Answer:
Hi XXXXXXX welcome back.

If pain is occurring again and again, rule out

: Any physical activity which she might be doing after getting some relief
: Muscle tear
: Osteoporosis and vertebral collapse
: Deficiency of calcium and Vitamin D which is not corrected yet.

All these present with same symptoms as I mentioned before. Painkillers are masking the symptoms. You should consult orthopaedician for above mentioned disease and investigations to diagnose the cause. Also, try to follow all the advise I have mentioned in previous answer to relieve pain and observe improvement.

Hope it will help you. Thanks. Take care.

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Brief Answer:
Thanks for the appreciation

Detailed Answer:
Hi XXXXXXX I appreciate your gratitude.

If you are completely satisfied, kindly close the query and rate the advise. I will be thankful to you.
If still in doubt, do let me know, I would be happy to help you.

Thanks. Take care.

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