10. Male w/ low back pain

Question 1

97% of back pain is of mechanical origin

Answer 1

ex.
Lumbar strain 70%
Degenerative joint disease 10%
Disc herniation 4%
other

Question 2

Red Flags For Serious Illness or Neurologic Impairment with Back Pain

Answer 2

fever
    unexplained weight loss
    pain at night
    bowel or bladder incontinence
    neurologic symptoms

Question 3

Risk Factors for Low Back Pain

Answer 3

Prolonged sitting, with truck driving having the highest rate of LBP, followed by desk jobs.
Deconditioning.
Sub-optimal lifting and carrying habits.
Repetitive bending and lifting.
Spondylolysis, disc-space narrowing, spinal instability, and spina bifida occulta.
Obesity is a possible risk factor, but the evidence is limited and inconsistent.

Question 4

Pain worse with movement and sitting is suggestive of a mechanical cause of back pain, such as…

Answer 4

lumbar strain, disc herniation, or degenerative arthritis.

Question 5

Pain radiating down the leg and numbness indicate nerve involvement, such as…

Answer 5

in disc herniation

HY* note the pain radiating down the leg

Question 6

Pain that improves with the supine position suggests…

Answer 6

spinal stenosis and disc herniation

Question 7

Modified version of the straight leg raise (SLR) test:

Answer 7

While continuing to talk to the patient, raise each leg by extending the knee from 90 degrees to straight. If the pain is functional, the action is possible without difficulty. If the pain is due to structural disease, the patient will instinctively exhibit the “tripod sign” by leaning backward and supporting himself with his outstretched arms on the exam table.

Question 8

most neuropathic back pain is due to impingement of what nerves

Answer 8

L4, L5, and S1 nerve roots

Question 9

The Faber test looks for…

Answer 9

pathology of the hip joint or sacrum (sacroiliac pain from sacroiliitis).

Question 10

disc herniation is associated with exacerbation when

Answer 10

sitting or bending

and relief while lying or standing

Question 11

Other symptoms of disc herniation include

Answer 11

increased pain with coughing and sneezing

muscle weakness, such as foot drop

Question 12

no red flags and has had pain for only two weeks, so conservative therapy is appropriate

Answer 12

Conservative therapy for acute low back pain includes:

    Pharmacologic therapy (aspirin/NSAID and/or muscle relaxants)
    Local therapy (heat/cold).

Question 13

Treatment After Adequate Trial of Conservative Therapy

Answer 13

If a patient has been in pain for five weeks with progression of neurological deficit (such as absent reflex at the ankles) and poor pain control, it is reasonable to refer him to a spine surgeon for surgical consultation or a pain clinic for possible epidural steroid injection