Approach to Back Pain Flashcards
presence of nighttime pain
infection or malignancy
buttock or shooting leg pain that radiates below the knee; sciatica
disc problem
bowel or bladder dysfunction
nerve root compression
weakness/numbness/tingling
nerve root compression
abdominal or pelvic pain
pancreatitis or pyelonephritis
fever and chills
infection or malignancy
weight loss
malignancy
bilateral and nonspecific pain
mechanical
better with rest and worse with activity or position change
nonspecific back pain
worse with sitting, coughing, or sneezing
disc herniation
presence of swelling or masses
malignancy or infection
presence of erythema
infection
abnormalities in symmetry/new curvature problems
malignancy
tenderness over spinous process
fracture or infection of that vertebrae
tenderness of sacroiliac joint
spondylitis
sciatic nerve tenderness
disc herniation
paraspinal muscle tenderness
disc herniation
tenderness over costovertebral angle
pyelonephritis
Shoulder abduction
C5
elbow flexion (brachialis/biceps)
C6
elbow extension (triceps)
C7, C8
wrist flexion (flexor carpi radialis)
C7
wrist flexion (flexor carpi ulnaris)
C8
wrist extension
C6, C7, C8
Finger abduction of fingers 1-5
T1
Hip flexion
L1, L2
Hip extension
S1
Knee Flexion
L5, S1
Knee extension
L3, L4
Dorsiflection
L4
Plantar flexion
S1, S2
babinski maneuver
stroke lateral aspect of sole from heel to ball, curving medially across ball of big foot. Normal response: plantar flexion of big toe
inability to walk on heel
problem with dorsiflexion; L4, L5
inability to walk on toe
calf weakness; S1, S2
straight leg raise
puts pressure on L5 and S1 nerve root; pain suggestive of disc herniation
Mechanical Low Back pain
- Insult:* nonspecific
- Predisposing factors:* injury, old age
- History:*
a. acute, recurrent, or chronic
b. lumbosacral (no radiopathy)
c. worse with activity, better with rest
d. does not wake from sleep - Exam:* most things normal
Spinal Stenosis
- Insult:* degeneration of ligaments causing narrowing of canal
- Predisposing factors:* old age, congenital abnormalities, metabolic or endocrine disorders; associated with degenerative disease
- History:*
a. chronic
b. lumbosacral, but buttock or bilateral pain is common
c. worse with walking or standing but relived by sitting - Exam:* nonspecific
Disc Herniation
- Insult:* herniation of nucleus pulposus; compression of nerve root
- Predisposing factors:* trauma or strain, coughing
- History:*
a. acute or acute on chronic
b. worse with sitting or cough
c. pain radiates below knee and causes tingling/weakness/numbness
d. may cause bowel or bladder dysfunction
e. worse with movement better with rest - Exam:* tenderness over paraspinal muscles, motor weakness, decreased reflexes, loss of light touch sensation
Infectious/Inflammatory disease
- Insult:* localized inflammation
- Predisposing factors:* IV drug use, recent infection
- History:*
a. can occur in any location
b. no relief with rest, wakes from sleep
c. fever, chills, fatigue
d. may involve weight loss, night sweats - Exam:* fever, looks ill
Malignancy
- Insult:* tumor, usually metastasis
- Predisposing factors:* previous cancer, family history of cancer
- History:*
a. acute or chronic
b. constant, dull
c. present at night and wakes from sleep, not relieved by rest
d. weight loss, night sweats, fever
e. may/may not have neurologic symptoms - Exam:* may look ill or feverish
Pancreatitis
- Insult:* inflammation of pancreas
- Predisposing factors:* alcoholism, biliary tract disease, medication use
- History:*
a. acute and persistent pain
b. begins epigastric, radiates to back
c. relieved by sitting forward
d. worse when lying down
e. worse with alcohol or fatty meals
f. associated with nausea and vomiting - Exam:* epigastric tenderness, diminished breath sounds
Pyelonephritis
- Insult:* kidney infection
- Predisposing factors:* frequent sexual activity or pregnancy, previous UTI or kidney disease, anatomic abnormalities
- History:*
a. acute, progressive pain
b. fever, chills, nausea, vomiting, dysuria, hematuria, foul urine odor
c. elderly patients may have altered mental status - Exam:* lower abdominal tenderness, costovertebral angle tenderness
Aortic Aneurysm
- Insult:* break in vessel wall
- Predisposing factors:* men, elderly, tobacco and alcohol use, atherosclerosis, trauma, syphilis
- History:*
a. acute, severe pain associated with dissection
b. tearing chest pain, vague lumbar or groin pain
c. pain could extend to shoulder, hoarseness
d. may have constipation, bloating, urinary retention - Exam:*
a. may have bradycardia, difference in blood pressures and pulses
b. pulsatile mass in central abdomen
