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MSK Week 3 2017/18 > 5: Back pain MDT > Flashcards

5: Back pain MDT Flashcards

1
Q

What common health problem puts a lot of strain on the spine?

A

Obesity

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2
Q

Where is localised back pain usually found?

A

Lumbar spine

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3
Q

What is a common form of referred back pain?

A

Sciatica (L4-S3)

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4
Q

Back pain often affects a patient’s ability to ___ and ___.

A

sleep , work

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5
Q

What should be asked about pain when taking a history?

A

SOCRATES

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6
Q

What should be asked about loss of function while taking a history?

A

ICE - how does it affect your daily life; ability to work?

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7
Q

Patients with back pain should be asked about past ___ and ___ in their medical history.

A

trauma , surgery

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8
Q

Back pain may be due to pathology in other ___.

A

systems

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9
Q

If there’s concern that a patient has inflammatory back pain, what tests should be carried out?

A

Blood test - inflammatory markers, calcium, ALP

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10
Q

Why are X-rays rarely carried out for people with back pain?

A

Lots of irrelevant details which can throw you

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11
Q

What scan is better at picking up spinal pathology and is carried out by specialists?

A

MRI scan

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12
Q

As a GP, in which cases would you request an:

a) X-ray
b) MRI scan

along with secondary referral for a patient presenting with back pain?

A

a) Red flag symptoms, trauma and/or osteoporosis

b) Non-resolving sciatica > 4 weeks and/or neurogenic claudication

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13
Q

What is the mnemonic used to remember X-ray changes in osteoarthritis?

A

Loss of joint space

Osteophytes

Sclerosis

Subarticular cysts

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14
Q

Most back pain is (mechanical / inflammatory).

A

mechanical

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15
Q

Some back pain can be caused by inflammatory conditions such as?

A

Ankylosing spondylitis

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16
Q

Can back pain be caused by infection?

A

Yes

17
Q

Generally, what are the yellow flags for chronic back pain?

A

Social / behavioural factors which impede their recovery

18
Q

What is the key principle when managing patients with back pain?

A

Don’t hurt them

19
Q

What percentage of patients with back pain are dealt with in general practice?

A

80-90%

20
Q

What percentage of orthopaedic referrals are for back pain?

A

20%

21
Q

What government system has a big impact on the way patients deal with their back pain?

A

Benefit system

22
Q

The longer (in months) a patient is off work with back pain, the (lower / higher) their chances of returning to work.

A

lower

23
Q

What model is used in the management of patients with back pain?

A

Biopsychosocial model

24
Q

What are the two most significant factors deciding the outcome of patients with back pain?

A

Accident at work with litigation

Psychological issues following it

this is regardless of diagnosis, surgery or patient factors

25
Q

Which percentage of patients referred to orthopaedics with back pain are actually operated on?

A

2.5%

26
Q

Findings of scans must be ___ to the presentation of the patient.

A

related

27
Q

Most prolapsed discs, if given time, will settle without surgery. When is surgery considered?

A

After 3 months when the patient has been off work for too long

28
Q

5/10 years later, are there any differences between the outcomes of disc prolapse patients who were operated on vs those who weren’t?

A

No

29
Q

People with which spine pathology tend to have claudication?

A

Spinal stenosis

30
Q

How do people relieve the claudication of spinal stenosis?

A

Flexion (lean forward)

31
Q

Spinal stenosis patients have difficulty walking downhill - why?

A

Claudication relieved by flexing

Spine extends when we go downhill - exacerbates claudication

32
Q

What activity do people with spinal stenosis find quite easy?

A

Cycling

33
Q

How is

a) vascular claudication
b) spinal claudication relieved?

A

a) Rest
b) Flexion of spine

34
Q

How do patients with intermittent vascular claudication find uphill walking?

Spinal claudication patients experience walking up hill differently - why?

A

Painful - due to muscle ischaemia

Fine - when they walk uphill their spine tends to be flexed

35
Q

Walking (uphill / downhill) exacerbates spinal claudication.

A

Downhill - because spine is EXTENDED

36
Q

How are disc prolapse and spinal stenosis treated?

A

Decompression / Discectomy / Stabilisation by fusion

37
Q

Discogenic pain is (better / worse) on flexion.

A

worse

Remember that spinal stenosis is better on flexion

38
Q

If facet joints are fused together to treat facet arthropathy, what disease can follow?

A

Adjacent segment disease

i.e facet arthropathy above and below due to presence of foreign material

MSK Week 3 2017/18 (7 decks)

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