Difference between flank pain and CVA tenderness?

[Syndrome2013]

So I know CVA tenderness is specific to Kidney related to problems (such as masses pyelonephritis, staghorn calculi) but NOT due to problems from ureters down. But what exactly causes flank pain. Is it pain originating from retroperitoneal structures in that area? Or is flank pain always (or almost always) related to kidney problems in addition to ureters etc.

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[chrisisinnocent]

CVA tenderness is a sign elicited on exam (you basically bang your fist at the CV angle and the patient reports pain).
Flank pain is reported by the patient and is a symptom. The cause can be kidney issues (generally infection or stone) but could be musculoskeletal or even referred pain from scary things like a retroperitoneal bleed etc.

 

[45408]

Low rib fractures can cause quite a bit of flank pain, and it will be reproducible with fairly gentle palpation. If you have to bang on their kidneys to elicit tenderness, then it's probably not rib fractures.

 

[Rendar5]

Pain is a symptom. Tenderness is a sign.
Patient reports pain, you elicit tenderness.

 

[armybound]

CVA tenderness is a sign elicited on exam (you basically bang your fist at the CV angle and the patient reports pain).
Flank pain is reported by the patient and is a symptom. The cause can be kidney issues (generally infection or stone) but could be musculoskeletal or even referred pain from scary things like a retroperitoneal bleed etc.

Exactly, sign vs symptom

 

[powermd]

So I know CVA tenderness is specific to Kidney related to problems (such as masses pyelonephritis, staghorn calculi) but NOT due to problems from ureters down. But what exactly causes flank pain. Is it pain originating from retroperitoneal structures in that area? Or is flank pain always (or almost always) related to kidney problems in addition to ureters etc.

As a pain specialist who sees a few patients each week with chronic flank pain, I thought I'd chime in with some additional explanation I never had in medical school. I do a lot of diagnostic and therapeutic injections using ultrasound guidance which is very cool, because you can really zero in on what structure is associated with a patient's pain. Among these patients I frequently find the pain is associated with the oblique abdomenis musculature, either along the superficial or intermuscular fascia. Oftentimes it seems to occur along the ridge formed by the T11 or T12 rib (any kind of 'bony prominence' in the body can be associated with pain). Sometimes it's an painful intercostal muscle, such as T11-12. Pain further posterior can occur at the edge of the connective tissue sheath for the erector spinae, or anteriorly at the edge of the rectus. The medical term for these painful spots is "trigger points" and there is no single accepted explanation for the nature of these things. My suspicion is that they represent small adhesions between muscle groups, or along fascia that tug when you put traction on them, causing pain. Injecting them breaks up the adhesion. Most doctors do these blind with variable results. Doing mine image guided I almost always achieve lasting pain relief after only 1-2 sessions.

 

[Syndrome2013]

Thanks guys..... I googled the difference between the two but never picked up on the sign vs. symptom part.

 

[FunnyCurrent]

Thanks guys..... I googled the difference between the two but never picked up on the sign vs. symptom part.

I am curious, is PBL not part of your curriculum?