1- back pain, spinal deformity & red flags Flashcards
what length of back pain is it then called chronic?
more than 3 months
what are areas where back pain is felt?
- neck (cervical pain)
- middle back
- lower back (most common)
- tailbone
what are common causes of back pain?
- degenerative (sprain, disc disease, spinal stenosis)
- vascular (aortic dissection, spinal SAH)
- neoplasm
- infection
- inflammation (ankylosing spondylitis)
- trauma
- metabolic disorder (crystal deposition diseases like gout)
- neighbouring viscera
what are back pain red flags?
- neurological deficit (numbness or weakness)
- history of cancer
- systemic features like fever, chills, night sweats
- IV drug use
- immunosuppression
- trauma
- osteoporosis
- thoracic back pain
- pain at rest & night
- age <50yrs or >16yrs
what type of back pain might indicate neoplasm?
severe unrelenting pain, nocturnal pain, unrelieved by bed rest
what is low back pain examination?
LOOK, FEEL, MOVE
Look = deformity, curvature
Feel = spine, paraspinal musculature, SIJ
Move = flex, extend & lateral bend spine & hip
Tests - SLR, FABER (test for hip arthritis), neurological exam (power, tone, reflexes), vascular exam
what are causes of degenerative neck pain?
cervical spondylosis (wear&tear), cervical radiculopathy (pinching nerve root), cervical myelopathy (compression of nerve roots by inflammation)
what are causes of infection causing neck pain?
discitis, osteomyelitis, epidural abscess
what are causes of inflammation causing neck pain?
rheumatoid arthritis, psoriatic arthritis
what viscera problem can cause neck pain?
carotid dissection
what symptoms can be meningitis?
headache, fever, stiffness, neck pain = red flag
*note = meningitis is serious infection of meninges which is membranes that protect brain & spinal cord
what are some tests to assess nerve root compression in cervical spine?
- spurling’s arm compression (apply downward pressure on bending patient head to side, if pain radiates to arm then +ve)
- overhead abduction relief (patient puts head on head and decrease in arm pain then +ve test)
what are some back pain diagnoses that are red flag emergencies?
- Traumatic fracture or dislocation
- Cauda equina syndrome
- Acute foot drop
- Acute cord compression
- Spinal infection
what are some common risk factors for spinal fracture?
- elderly patients
- osteoporosis
- long term steroid use
what are upper motor neuron signs that should prompt further assessment in back pain?
- Hyperreflexia = exaggerated reflexes
- Spasticity= increased muscle tone leading to stiffness
- Positive Babinski sign = big toe extends upwards when sole foot stroked
- Clonus = involuntary, rhythmic muscle contractions following a sudden stretch of muscle (hit tendon with hammer)
*remember that upper motor neurons = nerves that control motor function
what is cauda equina syndrome?
Dysfunction of multiple lumbar & sacral nerve roots caused by - cauda equina compression from large central herniated lumbar disc prolapse, tumour, etc
what are typical features of cauda equina syndrome?
urinary retention, urinary or faecal incontinence, saddle anaesthesia (numbness where sit on saddle)
what is acute foot drop?
red flag of back pain where weakness of ankle dorsiflexion - you grade muscle weakness out of 5
what is acute cord compression?
sudden & severe compression of spinal cord resulting in rapid onset of neurological symptoms like severe weakness/numbness of extremities
= it’s a red flag
what is spinal osteomyelitis?
infection of the vertebrae, typically caused by bacteria (most commonly Staphylococcus aureus), though fungal infections can also be a cause. This condition can result in the destruction of vertebral bone tissue and, if left untreated, may lead to severe complications such as spinal abscesses, vertebral collapse, or even spinal cord compression.
who is at risk for spinal osteomyelitis?
IV drug users, recent infection, recent spinal surgery or epidural catheter placement