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OPP 2-1 > 3- Low Back Pain - An Osteopathic Approach > Flashcards

3- Low Back Pain - An Osteopathic Approach Flashcards

1
Q

How long do you have to have back pain to be considered Chronic Low Back Pain?

A

> 3 months

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2
Q

A patient presents with lower back pain, what two prognosis must you eliminate immediately?

A

1) Cauda equina syndrome

2) Abdominal Aortic Aneurysm (AAA)

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3
Q

What is Cauda Equina Syndrome?

A

A large central disc herniation or other space occupying lesion compressing the cauda equina.

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4
Q

What are potential symptoms of cauda equina syndrome?

A

Sciatica
saddle anesthesia
lower extremity weakness
bowel or bladder dysfunction

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5
Q

What is the treatment of cauda equina syndrome?

A

Decompressive surgery within 12 hours of onset of symptoms

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6
Q

What are the symptoms for a non-dissecting Abdominal Aortic Aneurysm (AAA)?

A

Hearing bruits or palpating a widened aorta

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7
Q

What are the symptoms for a dissecting Abdominal Aortic Aneurysm (AAA)?

A

Sudden onset of severe, tearing abdominal pain radiating to the back. May also hear bruit or palpate a widened aorta.

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8
Q

A patient presents with a dull continuous back pain and a low-grade fever of 99 degrees with a spasm over the paraspinals. What is the likely problem?

A

Diskitis or Osteomyelitis.

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9
Q

A patient with Diskitis or Osteomyelitis often has what type of HPI?

A

History of UTI, IV drugs, skin abscess or lumbar puncture

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10
Q

A 51 year old female patient presents with lower back pain that has gradually started and increased. At night, she says she still has pain and it is unrelieved by lying down or bed rest. She also lost a lot of weight recently. What could be her problem?

A

Tumor. IT IS A TUMOR! Blahhhhg!

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11
Q

Two 18 and 30 year old males present with morning back pain and SI joint pain/stiffness. When they work out, their pain decreases. What could be their problem? How do you test for this?

A

Ankylosing Spondylitis; Test for HLA B-27 (Hereditary autoimmune disease)

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12
Q

What are the general categorical causes for Low back pain?

A 
Infection
Tumor
Rheumatologic
Metabolic
Psychogenic
Vasculogenic
Viscerogenic
Mechanical
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13
Q

Which is not a tumor related cause of LBP?

a) myeloma
b) sarcoma
c) prostate metastatic caner
d) metastatic breast cancer
e) fibromyalgia

A

e) fibromyalgia

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14
Q

Which is not a rheumatologic related cause of LBP?

a) akylosing spondylitis
b) psoriatic arthritis
c) osteomyelitis
d) rheumatoid arthritis
e) fibromyalgia

A

c) osteomyelitis (infection, not rheumatologic related)

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15
Q

What is the most common metabolic cause of Low Back Pain? WHat do you ask/check?

A

Osteoporosis.

Check bone density on postmenopausal women. Ask if they are shorter.

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16
Q

What are some psychogenic causes of Low Back Pain?

A

Depression
Somatization
Malingering

17
Q

What are Vasulgenic causes of Low Back Pain

A

Aortic aneurysm

Epidural venous anomalies

18
Q

What are Viscerogenic causes of Low Back Pain?

A
  • Renal Colic (kidney stone?)
  • Inflammatory bowel diseses (Crohn’s or Ulcerative Colitis
  • Endometriosis
19
Q

How many different mechanical causes of low back pain exist?

A

a lot. seriously.. a lot.

20
Q

What are common histories of patient with chronic low back pain?

A 
Recent injury
Prior cancer
Chronic Corticosteroid use
Recent lumbar puncture
Fevers, Chills, night sweats
21
Q

A patient presents with low back pain that gradually started days later. The pain gets worse with activity and relieved with rest. What type of low back pain is the patient experiencing?

A

Myofascial Pain

22
Q

A patient presents with low back pain that gets worse with sitting, radicular pain and parestesias along the backside of his thigh. Pain increases when he is constipated and trying to take a dump (Valsalva maneuver). What type of low back pain is the patient experiencing?

A

Disc Pain

23
Q

A 40 y/o patient presents with low back pain that that gets worse at night. He also experiences fever, chills, night sweats, weight loss and constant pain. What type of low back pain is the patient experiencing?

A

Neoplastic pain

24
Q

A 13 year old gymnast comes in complaining of chronic lower back pain. The pain often gets worse when she extends her back on her left side. What type of low back pain is the patient experiencing?

A

Spondylyticpain

25
Q

What are the red flags of chronic low back pain?

A
  • Recent trauma
  • Unexplained weight loss or feer
  • Immunosuppression
  • Cancer (or history of cancer)
  • IV drug use
  • Osteoporosis/glucoorticoid use
  • Age 70+
  • Focal neurologic deficit progressive or disabling -symptoms
  • Duration 6+ weeks
26
Q

If you suspect an L4 root problem, what do you test?

A

patellar reflex and quad strength

27
Q

If you suspect an L5 root problem, what do you test?

A

Heel walking

Ankle and Big Toe dorsiflexion

28
Q

If you suspect an S1 root problem, what do you test?

A

Achilles Reflex

Tiptoe walking

29
Q

If you suspect malingering, what do you test?

A

Straight leg raise for positive radicular pain either seated or supine.

30
Q

If you suspect a red flag for chronic low back pain, what do you order for the patient?

A

X-rays

31
Q

What are the risks for Recurrent Low Back Pain?

A
  • Sedentary lifestyle
  • Continued weakness (Core)
  • Low endurance
  • limited flexibility (hamstrings)
  • Overweight
  • Improper Mechanics
32
Q

What are potential indications for Surgery?

A
  • Progressie, moderate to severe neurologic deficit
  • Persistent, intolerable radicular symptoms despite adequate trial of conservative care (OMT< PT, NSAIDS, epidural/facet injection)
33
Q

What OMT can be used for Chronic Low Back Pain?

A
  • Soft Tissue (because chronic soft tissue changes often cause/maintain low back pain).
  • Viscerosomatic reflex check
34
Q

How can manipulative treatment help with Chronic low back pain?

A

OMT may improve mobility, remove restrictions, and restore function.

35
Q

What are common muscular problems in CLBP (chronic low back pain)?

A
  • Quadratus lumborum (Aching LBP)
  • Iliopsoas (forward bent posture)
  • Piriformis (“sciatica”)
  • Gluteus medius
  • Lumbar Paraspinal muscles
  • Hamstrings

OPP 2-1 (16 decks)

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