Acute Low Back Pain Flashcards
What are some red flag symptoms of low back pain?
- unrelenting pain at night/rest
- neuromotor deficit
- duration greater than 6 weeks (most benign back pain resolves in 2 weeks)
- loss of bowel/bladder control
- age greater than 70
- unexplained fever
- trauma
- alcohol abuse/IV drug use
- hx of cancer
Increasing neurologic defiicits, leg weakness, bowel and/or urinary incontinence, anesthesia/paresthesia in saddle distribution, bilateral sciatica, pain elicited by straight leg test, reduction in anal sphincter tone, decreased ankle reflexes bilaterally
cauda equina syndrome
how to manage cauda equina syndrome
immediate lumbosacral MRI, corticosteroids for pain/inflammation, immediate surgical decompression of cauda equina to prevent further neurological damage
Fevers, point tenderness over vertebrae
infectious procses (osteo, epidural of paraspinous abscess,)
check CBC and ESR
unexplained weight loss, worsening pain at night, failure to improve 1 month after conservative therapy
think cancer
What is sciatica and what is it a classic sign of?
sharp burning back pain that radiates down the back and side of the leg and distal to knee, improves lying down and increases with valsalva, coughing, sneezing…classic sign of herniated disc
How to test for sciatica
straight leg raise test and contralateral leg raise test along with sensory/reflex testing
conservative treatment for sciatica
NSAIDS, acetominophen, muscle relaxants (i.e. cyclobenzaprine), opoids in extreme cases
Congenital or acquired condition of spinal canal narrowing with or without concomitant facet hypertrophy that exerts presssure on spinal cord and nerve roots
spinal stenosis
What are the most common acquired causes of lumbar spinal stenosis
degenerative arthritis and spondylolisthesis
Presentation of spinal stenosis
lower back and leg pain, leg weakness, pseudoclaudication that occurs after walking various distances (although vessels are not compromised).
Pain relieved by sitting, performing lumbar flexion, squatting, or lying down
How to treat spinal stenosis
NSAIDS, muscle relaxants, PT, epidural corticosteroid injections
Risk factors for vertebral compression fractures
older age, chronic corticosteroid use, osteoporosis
What pain distribution to vertebral fractures usually follow?
contiguous nerve and radiates bilaterally to anterior abdomen and pelvis ‘“girdle of pain”
T/F: psychosocial factors are predictors of slow recovery and increase risk of developing chronic low back pain
TRUE. evaluate for these
