10 back pain Flashcards
three most common causes back pain
lumbar strain/sprain
age-related ddd
herniated disc
acute sciatica
lbp with radiculopathy below the knee and sxs lasting up to 6 weeks
red flags back pain
fever, unexplained weight loss, pain at night, bowel or bladder incontinence, neurological sxs, saddle anesthesia
osteoporosis risk factors
disc herniations sxs
pain worse with sitting or bedning, relief with lying or standing pain with cough/sneeze pain radiating down leg paresthesias muscle weakness
pe back
standing - inspect, palpate, rOM, gait, stoop test
seated - reflexes, strength , sensation
supine = abdominal, rectal, SLR, crossed leg raise, FABER (hip)
stoop test
standing to squatting
central stenosis = reduce pain
reflex grade
0 1+ decreased 2+ normal 3+ increased 4+ clonus
decrease patella
L3-L4
decreased achilles
S1
hyperreflexia
UMN sydnrome with spinal cord compression
normal muscle strength
5/5
L3
patellar
lateral thigh and medial femoral condyle
exten quadriceps
squat and rise
L4
patellar
medial leg and medial ankle
dorsiflex ankle
walk on heels
L5
medial hamstring
lateral leg and dorsum of foot
dorsiflex great toe
walk on heels
S1
achilles tendon reflex
posterior calf, sole of foot, lateral ankle
stand on toes
walk on toes
straight leg raise
raise each leg by enxtending the knee from bent to straight
modified = sitting
true = laying and raise
tx back pain
aspirin/NSAID and/or muscle relaxants, tylenol
local therapy (heat cold)
activity
phth
if iin pain 5_ weeks with progression of neuro deficit and poor pain control, refer to spine surgeon or continue conservative tx
xray when
hx trauma strenous lift with osteoporosis prolonged steroid use osteoporosis age < 20 or > 70 hx cancer fevers/chills/weight loss pain worse when supine or severe at nihgt fx, tumor, infection
mri when
worsening or unremitting pain progressive major motor weakness cauda equina systemic disodrer failed 6 weeks conservative
