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4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) > [31] Back Pain > Flashcards

[31] Back Pain Flashcards

1
Q

What causes mechanical pain of the back?

A

Soft tissue injury leads to dysfunction of the whole spine, which leads to muscle spasm and main

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2
Q

What may cause mechanical back pain?

A

An inciting event, e.g. lifting

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3
Q

Who should mechanical back pain be suspected in?

A

Younger patients with no sinister features

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4
Q

What is involved in the conservative management of mechanical back pain?

A 
Max 2days bed rest 
Education - keep active, how to lift etc
Physiotherapy
Address psychosocial issues regarding chronic pain and disability
Warmth
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5
Q

What is involved in the medical management of mechanical back pain?

A

Analgesia

Muscle relaxant

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6
Q

What analgesia is used in the medical management of mechanical back pain?

A

Paracetamol
NSAIDs
Codeine

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7
Q

What muscle relaxant is used in medical management of mechanical back pain?

A

Low-dose diazepam

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8
Q

What is the limitation of diazepam in the management of mechanical back pain?

A

It is only for short-term use

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9
Q

What happens in disc prolapse?

A

Herniation of nucleus pulposus through annulus fibrosis

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10
Q

Which nerve roots are most commonly compressed in disc prolapse?

A

L5 and S1

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11
Q

What disc prolapse compresses the L5 root?

A

L4/5

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12
Q

What disc prolapse compresses the S1 root?

A

L5/S1

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13
Q

How might disc prolapse present?

A

As severe pain on sneezing, coughing, or twisting a few days after a low back strain

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14
Q

What is lumbago?

A

Lower back pain

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15
Q

What is sciatica?

A

Shooting radicular pain down buttock and thigh

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16
Q

What are the signs of a disc prolapse on examination?

A

Limited spinal flexion and extension
Free lateral flexion
Lesague’s sign

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17
Q

What is Lesague’s sign?

A

Pain on straight-leg raise

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18
Q

What might a lateral herniation cause?

A

Radiculopathy

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19
Q

What might a central herniation cause?

A

Corda equina syndrome

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20
Q

What examination signs might be seen in a disc prolapse causing L5 root compression?

A

Weak hallux extension, with or without foot drop

Decreased sensation on the inner dorsum of the foot

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21
Q

How can foot drop due to L5 radiculopathy be distinguished from peroneal nerve palsy?

A

Weak inversion in L5 radiculopathy

22
Q

What examination signs might be seen in a disc prolapse causing S1 root compression?

A

Weak foot plantarflexion and eversion
Loss of ankle-jerk
Calf pain
Decreased sensation over the sole of the foot and back of calf

23
Q

How is a suspected disc prolapse investigated?

A

MRI

24
Q

When does the MRI need to be done as an emergency in suspected disc prolapse?

A

If cauda equina

25
Q

What is involved in the conservative management of a disc prolapse?

A

Brief rest
Mobilisation
Physiotherapy

26
Q

What is involved in the medical management of disc prolapse?

A

Analgesia

Transforaminal steroid injection

27
Q

In what % of patients is brief rest, analgesia, and mobilisation effective?

A

> 90%

28
Q

What is involved in the surgical management of disc prolapse?

A

Discectomy or laminectomy

29
Q

When might the surgical management of disc prolapse be required?

A

Cauda equina syndrome

Continuing pain or muscle weakness

30
Q

What is the most common surgical procedure done for disc prolapse?

A

Lumbar microdiscetomy

31
Q

What happens in a lumbar microdiscectomy?

A

Microscopic resection of the protruding nucleus pulposus

32
Q

What approach is taken in a lumbar microdiscectomy?

A

Posterior approach, with the patient in the prone position

May be performed endoscopically

33
Q

What is spondylolisthesis?

A

Displacement of one lumbar vertebra on another

34
Q

What direction does spondylolisthesis usually occur?

A

Forward

35
Q

What vertebra is usually affected in spondylolisthesis?

A

L5 onto S1

36
Q

How can spondylolisthesis sometimes be detected?

A

May be palpable

37
Q

What are the causes of spondylolisthesis?

A

Congenital malformation
Spondylosis
Osteoarthritis

38
Q

When does spondylolisthesis present?

A

In adolesence or early adulthood

39
Q

How does spondylolisthesis present?

A

Pain, worse on standing, with or without sciatia, hamstring tightness, and abnormal gait

40
Q

How is spondylolisthesis diagnosed?

A

Plain radiography

41
Q

How is spondylolisthesis managed?

A

Corset
Nerve release
Spinal fusion

42
Q

What causes spinal stenosis?

A

Developmental predisposition, with or without facet joint osteoarthritis leads to generalised narrowing of lumbar spinal canal

43
Q

How does spinal stenosis present?

A

Spinal claudication

Pain on spine extension

44
Q

Describe the features of spine claudication

A

Aching or heavy buttock and lower limb pain on walking
Rapid onset
May come with parasthesia/numbness
Pain eased by leaning forwards

45
Q

How is spinal stenosis investigated?

A

MRI

46
Q

How is spinal stenosis managed?

A

Corsets
NSAIDs
Epidural steroid injection
Canal decompression surgery

47
Q

What are the neurosurgical emergencies?

A

Acute cord compression

Acute cauda equina compression

48
Q

What are the symptoms of acute cord compression?

A

Bilateral pain in the back and radicular area
LMN signs at compression level
UMN signs and sensory disturbance level below compression
Sphincter disturbance

49
Q

What are the symptoms of acute cauda equina compression?

A

Alternating or bilateral radicular pain in legs
Saddle anaesthesia
Loss of anal tone
Bladder and bowel incontinence

50
Q

How is acute cord compression/acute cauda equina compression managed if caused by large prolapse?

A

Laminectomy/discectomy

51
Q

How is acute cord compression/acute cauda equina compression managed if caused by tumours?

A

Radiotherapy and steroids

52
Q

How is acute cord compression/acute cauda equina compression managed if caused by abscesses?

A

Decompression

4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) (38 decks)

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