Aquifer Case 10 Flashcards
what are MSK causes of back pain?
AXIAL
1. degenerative disc disease
- facet arthritis
- sacroilitis
- ankylosing spondylitis
- discitis
- paraspinal msucular issues
- SI dysfunction
RADICULAR
1. disc prolapse
- spinal stenosis
TRAUMA
1. lumbar strain
- compression fracture
what are the non-MSK causes of back pain?
NEOPLASTIC
1. lymphoma/leukemia
- metastatic disease
- multiple myeloma
- osteosarcoma
INFLAMMATORY
1. RA
VISCERAL
1. endometriosis
- prostatitis
- renal lithiasis
INFECTION
1. discitis
- herpes zoster
- osteomyelitis
- pyelonephritis
- spinal or epidural abscess
VASCULAR
1. aortic aneurysm
ENDOCRINE
1. hyperparathyroidism
- osteomalacia
- osteoporotic vertebral fracture
- Paget disease
GI
1. pancreatitis
- peptic ulcer disease
- cholecystitis
GYNECOLOGICAL
1. endometriosis
- pelvic inflammatory disease
what are the 3 most common causes of back pain?
- degenerative joint disease
- disc herniation
- lumbar strain (70%)
what is sciatica?
lower back pain with radiculopathy below the knee and symptoms lasting up to six weeks
caused by a variety of conditions: disc herniation, lumbar spinal stenosis, facet joint osteoarthritis or other arthropathies, spinal cord infection or tumor, or spondylolisthesis
what are the risk factors for low back pain?
- prolonged sitting
- deconditioning
- sub-optimal lifting and carrying habits
- repetitive bending and lifting
- spondylolysis, dis-space narrowing, spinal instability, spina bifida
- obesity
- prolonged use of steroids
- IV drugs
- anxiety, depression, stress
what are the red flags for serious illness or neurologic impairment with back pain?
- fever
- unexplained weight loss
- pain at night
- bowel or bladder incontinence
- urinary retention
- neurologic symptoms
- saddle anesthesia
- trauma
what are the standing portions of a lower back pain exam?
- squat
- walk
- check flexion
- inspect curvatures
- palpate paraspinal muscles
what are the differentials if ROM of the spine is limited?
- limited lumbar flexion = herniation, osteoarthritis, muscle spasm
- limited extension = degenerative disease or spinal stenosis
- lateral motion = bone pathology like osteoarthritis or neural compression
how do you rate muscle strength?
0/5 No movement
1/5 Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached.
2/5 Voluntary movement, which is not sufficient to overcome the force of gravity. For example, the patient would be able to slide their hand across a table but not lift it from the surface.
3/5 Voluntary movement capable of overcoming gravity, but not any applied resistance. For example, the patient could raise their hand off a table, but not if any additional resistance were applied.
4/5 Voluntary movement capable of overcoming “some” resistance
5/5 Normal strength
what are the signs of L5 vs S1 weakness?
L5 weakness = can’t walk on heels
S1 weakness = achilles tendon reflex
what does the straight leg raise test tell you?
if a patient only raises their leg <80 degrees, they have tight hamstrings or a sciatic nerve problem.
to differentiate between tight hamstrings and a sciatic nerve problem, raise the leg to the point of pain, lower slightly, then dorsiflex the foot – if there is no pain with dorsiflexion, the patient’s hamstrings are tight
test is positive if pain radiates down the posterior thigh past the knee which indicates stretching of the nerve roots
what does the crossed leg raise tell you?
the asymptomatic leg is raise and the test is positive if pain is increased in the contralateral leg
this indicates disc herniation
what is the FABER test?
Flexion
Abduction
External rotation
tests for sacrioiliitis
done by flexing the hip and placing the foot of the tested leg on the opposite knee – pressure is then placed on the tested knee while stabilizing the opposite hip
the test is positive if there is pain at the hip or sacral joint or if the leg cannot lower to the point of being parallel to the opposite leg from pathology of the hip, sacrum or sacroiliac joint.
what PE finding support disc herniation?
- drop foot
- pain worse with cough and sneezing
- pain worse with sitting (standing relieves disc herniation symptoms)
what are the symptoms associated with disc herniation?
- increased pain with coughing and sneezing
- pain radiating down the leg and sometimes the foot
- paresthesias
- muscle weakness, such as foot drop
- pain worse with sitting or bending
