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MSK 2 > Approach to Low Back Pain > Flashcards

Approach to Low Back Pain Flashcards

1
Q

3 categories of back pain

A

Nonspecific
Radiculopathy or spinal stenosis
Systemic dz

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2
Q

Red flag sx of note

A 
Over 50
System sx
Cancer
Night pain or worse with rest
Urinary probs 
Infection (skin and urinary)
Immunosuppression
Drug use
Durgs or osteoposis
Failrue to response
Trauam
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3
Q

Inspection

Palpation and percussion

A

INspect for curvature

Palpate each process for tenderness or step-offs

Stepo-offs may man spondylolisthesis

Pain is fracture,infection or arthritis

Palpate SI at L5 level…tenderenss is spondyloarthropathy

Palpate paravertebral muscles

Percuss for tenderness with unlar surface of fist of ver vertebra

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4
Q

ROM and special maneuvers

A

Flexion, extn, rotation, and lateral bending

Striaght lef raise - assesses for nerve root compression (sensitive)…lift affect extended leg…if pain in leg, extending blow knee then positive

Corssed straight leg rasie - specific for nerve root compression….supine and life unaffected leg…if pain in affected leg, then positive

Modified schober - mark of L5 and 10cm above that…when patients bends, distance hsould increase by 5 cm

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5
Q

L4 muscle, sensory, motor, screening, reflexes

A

Anterior tbilias

Medial calf and ankle

Extension of quads
S
Squatting and rising

Patellar

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6
Q

L5 muscle, sensory, motor, screening, reflexes

A

Extensor hallicus longus

Lateral ankle and dorsum of foot

Dorsiflexion of foot and great toe

Walking on heels

Not reliable

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7
Q

S1 muscle, sensory, motor, screening, relfx

A

Gastrocnemi,s sleus, peroneals

Planater-lateral foot

Plantar flexion of foot and great toe

Walk on toes

Ankele

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8
Q

Lumbar strain/spain

A

Lumbargo

Paraspinal muscle injury

Lumbar sprain is ligamentous injury

Can radiate to butt or post thight

Worse with activity and bening

May be after excessive use

Tenderness over paraspinals and restricted ROM, esp flexion

NSAIDS and strethcing for 4-6 weeks

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9
Q

Degeenrative dz

A

Spondylosis - intervetrt discs

OA- facet joints

As IV disk lost, it bulges and infolds the ligamentum flavum

Stres on facet joints leading to OA

Chronic dull ache

Maybe morning early stiffness lasting less than 15

Difficult to distinguish from lumbar strain

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10
Q

Scoliosis

A

Lateral curvature accompanied by rotation

Most are idiopathic

Pain in areas of defotmity

Adams forward bend test - bend at wait while keeping knees stragith…if positive, then rotational deformity with more prominency of ribs/scap on the right side

Can X-ray

NSAIDs and exercise

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11
Q

Kyphosis

A

Roundback defomrity opf thoracic spine

Convexity

Usually with aging

Thoracic back pain

Pain control and tx underlying osteoporosis

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12
Q

Compression fracture

A

Often no acute inciting event

Tenderness to palpation over the spinous process

Loss of vertebrla hegith on X ray

Pain managmenet, and osteroporotic management

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13
Q

Lumbar herniated disc

A

Herniation ovetime as weak posterolateral portion of annulus fibrosis develops fissures

Material creates chem irritation and compressive ffect on nerve root

Pain, numbness or wekaness in one of lower exteemitieis

Radiculus leg pain below knee follows onset of back pain

SCoughing and sneezing make it worse

MRI if sx byond 4-6 weeks

NSAIDs primary

epidural steroids in refractory

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14
Q

Spinal stenosis

A

Neurogenic claudication

Intervertebral disc degeneration leads to load shifted to facet joints

Fact osteoarthritis and hypertrophy leads to osteophytes

Narrowing of canal, facet joints, or neural fromaina

Radiation in buttock and thigh/lower leg

Wrose with lumbar extesnions and improved with lumbar flexion

True weakness uncommon

Propioception may be impaired with wide gait and positive romberg

Tx with NSAIDs and PT intiially…surgery if not

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15
Q

Degenrative spondylolisthesis

A

Forward slip of vertebra due to degen changes in facet and IV diskl

Over 40 and obese

Pain made worse with bending, twist, lifting

X-ray will show narrowing of joint space with IV disc slippage

Manage with NSAIDs, weight loss and exercise…may need surgery

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16
Q

Cauda equina

A

L2-S4 compression of multiple roots

Numbness in both legs, saddle paresthesia, incontinence, and weakness

Motor and sensory dysfunction

Decreased sphincter tone
Urinary retention

Emergent MRI and neurosurg eval…this is an emergecn y

17
Q

Spondyloarthrophy/AS

A

Persistent lower back pain in teens to 20s

Stooped posture and loss of mobility

SI tenderness

Schober test shows reduced flexibility

Sacroilitis

18
Q

Vertebral osteomyelitis

A

Heamtogenous, direct trauama/spinal surgery, or from soft tissue

Risk - IV, endocarditis, diabetes, immunocomp, spinal surg, older age

Segmental arteries supply blood to the vertebrae…arteries bifurcate and supply to inferior of one end plate and superior of other…infection typically involves 2 adjacenrt vertebral bodies and their IV disk

Back pain insidious and worsns over weeks

Tenderness of spinous processes

WBC and ESR elevated

Blood cultures positive most of the time

MRI is best test…ABs for at least 6 weeks

19
Q

Epidural abscess

A

Collection of pus between dura and vertebral column

Infection can invade via hematogenous psread or direct extension

Similar risk of osteomyleitis

Most common S auresu

Tirad of fever, back pain, and neuro deficits

WBC and ESR/CRP elevated

MRI is preferred

Srugical decompression, asbcess drainage, and L-T AB therpay

20
Q

Spianl metastases

A

Over 50m hx of cancer, or weight loss

Majority from carcinoma of breast, lung, portate, co,on, thyroid, or kidney

Progressive unrelenting pain worse at night is typical

Maybe radiculopathy

Tenderness along spinous processes

X-ray - loss of vertebral hieght or bny destruction with lytic or blastic lesions

MRI may be best

Bone scan can help but neg in multiple pyemloma

21
Q

Dscitis - toddlers

A

Under the age of 5, infection because of heavily vascularized disks and bacteremia

Graudal refusal to walk or a limp

Fever absent

Increase WBC and CRP/ESR

Important ot obstain blood cultures, but rarely positive

X-rays normal initially then show narrowing/plate changes

MRI is best

AB course

22
Q

Malignant tumors - toddlers

A

Unrelenting, progressive apin worse at night

Osteosarcoma and Ewings are most common primary…could also be from leukemia or metastitc dz

Leukemia may be associated with compression fractuers

Bone scan

23
Q

Vertebral osteomyelitis - schoo age

A

Spread form skin or other site

Insidious onset of constant back pain and resist walking

May appear ill and site may be inflamed

Increased WBW and CRP/ESR

Blood cultures essentials

X-rays negatvie for 10-14 days then periosteal thickening, elevation and focal osteopenia

MRI is best

Tx with extendied AB course

24
Q

Benign bone tumors - school aged

A

Osteoid osteoma and bone cysts

Osteoid - night pain relieved by NSAIDs and resolve on own

Cysts - chronic dull pain and can cause pathologic fracture…can see on X-ray but MRI pathologic

25
Q

MSK pain in adolescents

A

Chronic and intermittent related to overuse and poor mechanics

Tenderness over paraspinals or tight hamstrings

NSAIDs and PT…bed rest avoided…no imaging needed

26
Q

Spondylolysis - adolescents

A

Repitivie hyperextension of the lumbar spine due to sports

X-ray defect in pars interarticularis

Pain worse with extension and rleieved by flexion

Paraspinal tenderness and tight hamstrings with pain on extension

Activity mod, complete rest, full time bracing and retunr in 2-4 months

27
Q

Spondylolisthesis - adolescents

A

Uncommon

Bilateral fracture of pars interarticularis leads to anterior slippage of vertebra…more at L5-S1

Sx similar to spondylolysis but may have neuro sx

28
Q

Kypohosis - adolsecents

A

Most due to poor posture

May result from prolonged sitting

X-ray normal

PT

Scheurmann disorder is angled deformity of vertebral bodies…typically familial…typical toracic or thoracolumbar pain with activiy…X-ray shows anterior wedging of multiple vertebral bodfies…may need NSAIDs, PT, surg

29
Q

Idiopathic soliosis - adolescents

A

Most common

Abnormal curvature iwth oration

More in females

If adam forward bend test is abnormal, then scoliometer used to measure rotation

X-ray shows curvature

Angle reater than 10 degrees is diagnositic

Tx depends on sverity

MSK 2 (24 decks)

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