12: Lower Back Pain Flashcards
Lower back pain symptoms of _____ will usually go away.
Lower back pain symptoms of less than 3 months will usually go away.
T/F With lower back pain, it is not necessary to rush to imaging, esp after some type of movement, exercise, or heavy lifting.
True
Since back pain complaints may present in other parts of the body (d/t spinal nerve innervation), always have the spine in mind when dealing with _____.
Since back pain complaints may present in other parts of the body (d/t spinal nerve innervation), always have the spine in mind when dealing with extremities.
Compression fractures are common with _____.
Compression fractures are common with osteoporosis.
Nonmechanical spinal disorders are very uncommon (approximately 1% of low back pain). These include neoplasm, metastatic cancer, infections, inflammatory arthritis, and Paget’s disease. How might the pain differ with a nonmechanical cause?
Pain worsens at rest.
Which 6 conditions can cause referred back pain?
- PID
- Prostatitis
- Renal dx (pyelonephritis)
- Dissecting aortic aneurysm
- Gall bladder
- Ovarian cancer
What is the #1 cause of lumbosacral strain?
Improper lifting
After a lumbosacral strain, you should caution the patient that it may feel worse in the next _____.
After a lumbosacral strain, you should caution the patient that it may feel worse in the next 12-36 hours.
Which condition?
- May have pain along waistband and into buttocks.
- Aggravated by standing and flexion.
- Pain is typically alleviated with rest and standing.
Lumbosacral strain
Disc protrudes out between vertebrae.
Herniated disc
_____ and _____ may coexist with a herniated disc.
DJD and arthritis may coexist with a herniated disc.
Outer portion of disc tears and extruded material can lie on nerve and cause chronic and radicular pain.
Herniated disc
Do herniated discs usually resolve?
New ones can resolve in 4-6 weeks with PT and rest in young to middle-aged adults. Can take up to 6 months for total recovery. Area remains weak.
Reflexes are absent or diminished when a nerve is _____.
Reflexes are absent or diminished when a nerve is completely compressed.
What is the most common herniated disc and why?
L5-S1 b/c all our body weight rests on our lower spine.
This acute back injury presents with loss of bladder and bowel control and weakness in the legs.
Cauda Equina
Which spinal nerves are affected in cauda equina?
T12-L1
T/F Cauda equina is a surgical emergency.
True
Slippage of one vertebrae on top of another because of tears in ligaments that hold the spine straight.
Spondylolisthesis
Spondylolisthesis is most common in what age group?
<26 yo
Which condition?
- Tight hamstrings
- Hyperextension often reproduces pain
- Family hx often positive
Spondylolisthesis
Painful and progressive problem caused by compression or narrowing of the spinal cord or root canal.
Spinal Stenosis
Spinal stenosis is most common in what age group?
Elderly
Which condition?
- Gradual onset of neurogenic claudication
- Back and buttocks pain, and numbness or tingling with walking
- Relieved with sitting
- Leaning forward alleviates pressure
- Walking aggravates pressure
Spinal Stenosis (Pain is unremitting because spinal canal is becoming narrower)
Valsalva maneuver that causes radicular pain could indicate what?
Herniated disc
Nighttime pain may suggest what?
- Cancer
- Infx
Back pain combined with fever, weight loss, and malaise may suggest what?
Cancer that has metastasized to the spine
On the neuro exam, how can you differentiate between vascular or spinal problems?
Check pulses and temperature of leg (indicates vascular)
What are the 5 Waddell signs?
- Tenderness (excess or widespread)
- Simulation (pain reported with sham maneuvers)
- Distraction (less pain when attention is diverted)
- Regional (widespread give-away or dysthesia)
- Overreaction (disproportionate psychomotor responses)
T/F Acute back pain resolves within 6-12 weeks, regardless of treatment.
True. Chronic (persistent) has a tremendous impact on life.
Why is patience and understanding for patients with low back pain low?
You can’t see it
What condition?
- Radiculopathy with shooting pain down the leg.
- May be from injury or herniated disc.
Sciatica (radiculopathy along sciatic nerve)
Which test would initially be used for unrelenting rest pain?
X-ray (check for tumors)
Which tests are used with a suspicion of cancer or infection?
- CBC
- ESR
- UA
When would an MRI or bone scan be ordered?
Pain that persists beyond 4-6 weeks.
What tests are used with prolonged sciatica?
- MRI
- CAT scan
- If after 6-8 weeks, an electromyography
6 points of treatment for low back pain.
- NSAIDs
- Muscle relaxers
- Pain Meds
- Avoid opioids (can be addictive and doesn’t help with inflammation and muscle problem)
- Pain 4-6: Tylenol or Vicodin
- Pain 7-10: Duragesic patch
- Physical therapy (mainstay)
- Minimize back stress (avoid lifting, pushing, pulling)
- Patient education (what to expect, next steps, diagnostic options, how to prevent in future, f/u and expectation)
During the straight leg raise, the patient complains of radiculopathy down the opposite leg (you raise the right and it causes shooting pain in the left). What does this indicate?
Herniated disc
Where is the sciatic notch located?
Between SI joint and ischial spine in the mid-gluteal area.
What does a positive sciatic notch indicate and how would you treat?
- Potential sciatica, herniated disc.
- PT and antiinflammatories.
- If no better or gets worse in 4-6 weeks, consider additional imaging.
What is the center of the vertebral disc called?
Nucleus Pulposus
What is the outer edge of the vertebral disc called?
Annulus Pulposus
When might you test for the Waddell signs?
If you suspect malingering (feigning or exaggerating illness)
