Back ache Flashcards by Beth Mickel

what are some causes of back pain

viscerogenic 
spondylogenix 
discogenic 
neurogenic 
phychogenic

How well did you know this?

Not at all

Perfectly

what is a serious visceral cause of back pain

leaking abdominal aortic aneurysm

How well did you know this?

Not at all

Perfectly

abdominal causes of back pain

peptic ulcer 
gall bladder 
pancreatic 
gall bladder 
urterogenic
colonic

How well did you know this?

Not at all

Perfectly

presenting symptoms in back pain

back pain
leg pain
neurological symptoms

How well did you know this?

Not at all

Perfectly

possible causes for back pain

possible spinal pathology
nerve route problems
mechanical back pain

How well did you know this?

Not at all

Perfectly

questions to ask for back pain

SOCRATES

site 
onset 
character 
radiating 
associated symptoms 
timing 
exacerbating/relieving factors 
severity

How well did you know this?

Not at all

Perfectly

2 types of leg pain

referred

root

How well did you know this?

Not at all

Perfectly

describe referred leg pain

dull/knawing
buttock/thigh
rarely below the knee
ill defined sensory symptoms

How well did you know this?

Not at all

Perfectly

describe root leg pain

sharp/shooting/electric
invariable below the knee to foot and ankle
anatomical sensory/motor symptoms

How well did you know this?

Not at all

Perfectly

example of root leg pain

sciatica

How well did you know this?

Not at all

Perfectly

Neurological red flags in back pain

incontinence 
loss of control/awareness 
perineal numbness 
bilateral/unilateral symptoms 
no leg symptoms
parasthesia 
numbness 
weakness

How well did you know this?

Not at all

Perfectly

what social factors should u ask about when taking a back pain history

age
occupation
presence/absence of litigation

How well did you know this?

Not at all

Perfectly

when should you beware of a patient presenting back pain which could suggest litigation

when they can tell the exact date and time it starts

How well did you know this?

Not at all

Perfectly

red flags for back pain

non-mechanical pain
systemic upset
major, new neurological deficit
saddle anaesthesia +/- bladder or bowel upset

How well did you know this?

Not at all

Perfectly

what are some possible spinal pathologies

fracture (wedge fracture often OA)
tumours (metastatic)
Infection
Inflammatory arthritis (ankylosing spondylitis)

How well did you know this?

Not at all

Perfectly

what tumours metastasise to the spine

Bad -breast
boys -bronchus 
pee -prostate 
though -thyroid 
kidneys -renal

How well did you know this?

Not at all

Perfectly

what history suggests a spinal tumour

weight loss 
anaemia 
fatigue 
insidious onset back pain 
constant 
night pain

How well did you know this?

Not at all

Perfectly

history suggesting infection

Study These Flashcards

recent foreign travel

fever

what causes nerve root problems

Study These Flashcards

disc prolapse

what causes disc prolapse

Study These Flashcards

impaired disc nutrition
disc prone to damage by load, torsion, shear
disc tissue - free fragments
leads to profusion, extrusion, sequestration

what does a large vertebral canal lead to

Study These Flashcards

back pain from stretched annulus

wouldn’t cause sciatica

what does a small vertebral canal lead to

Study These Flashcards

root compression 
inflammatory mediators 
root pain and tension signs 
resolution/surgery 
may cause sciatica

what does loss of disc height lead to

Study These Flashcards

facet joint arthropathy leading to back pain

when it is out of alignment the bones rub like in OA

what does degenerative disc disease cause

Study These Flashcards

facet joint arthropathy
stenosis or narrowing or vertebral canal

cause by loss of water in ageing

whats the most common type of back pain

mechanical

how do you diagnose mechanical back pain

diagnosis of exclusion no nerve root cause no spinal pathology

what is spndylolysis

linear crack - stress break along the collar of the scotty dog (pas interarticularis)

what is spndylolisthesis

break on the neck of the scotty dog (pas interarticularis) allows the vertebrae to slide on the one above

examination steps for back pain

observation - does it look straight, are curves normal range of movement - schrobers test, lateral movements neurological examination

what causes loss of lumbar lordosis

spasm | ankylosing spondylitis

what do you look at in neurological examination

Myotomes dermatomes reflexes nerve irritation

what are the myotomes

L1/2 - hip flection L3/4 knee extension L5 - foot dorsiflection & EHL S1/S2- ankle plantarflextion

how to check for nerve irritation

straight leg raise test | shooting pain down the leg along the dermatome shows nerve irritation

what is pain drawing

where a patient marks on a picture where their pain is can show whether dermasomal or not

what are overt pain behaviours

``` guarding bracing rubbing grimacing sighing ```

what are behavioural responses (Waddell)

``` superficial/non anatomical tenderness simulation distraction (straight leg raise) over reaction to examination regional sensory disturbance ```

Investigations for back pain

X-rays not very useful MRI- not the answer, 76% false positives Myelogram CT

specialised investigations for back pain

myelogram CT- contrast enhanced provocation discography selective nerve block

what is sciatica

buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

what is disc prolapse surgery for

leg pain removed fragments of disc pressing on nerve root effect on neurology unpredictable

common presentation of disc prolapse

episodic back pain onset of leg pain +/- neurology leg pain becomes dominant myotomes and dermatomes

what happens if you leave the disc prolapse alone

70% settle in 3 months 90% settle in 18-24 months surgery carries risk and is only done if its having a massive effect on the patients life style

First line treatment for back ache

``` Conservative short bed rest (debatable) anti-inflammatory +/- muscle relaxant mobilise thereafter physical therapies return to normal activity ```

second line treatment for back pain

``` education/inttruction/reassurance physiotherapy osteotherapy TENS, psychology/pain clinic complementary therapies surgery ```

Back ache Flashcards

(44 cards)