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Musculoskeleton > Back and neck Pain > Flashcards

Back and neck Pain Flashcards

1
Q

Back pain common epidemiology

A

Back pain 2nd only to URI, most common in ages of 30-45

  • # 1 cause of disability in US. (Most common reasoning for X-rays, CT or MRI)
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2
Q

Acute vs chronic back pain

A

<6 week =acute

> 6 weeks chronic

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3
Q

TUNA FISH

A

Trauma
Unexplained weight loss
Neurological symptoms
Age greater than 50

Fever
IV Drug
Steroid use
History of cance

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4
Q

Claudia equina syndrome

A

compression of the Cauda equina can permanently perminantly paralysis

  • usually caused by overflow of bladder which compresses it
  • saddle Anaesthesia is common
  • weakness of legs
  • loss of lower extremity reflexes
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5
Q

Sciatic

A

Herniated IVD disc impinges sciatic nerve that causes lower extremity paralysis and muscle weakness

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6
Q

Spinal infections are most common from where?

A

Hematogenous spread via UTI

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7
Q

Osteomyelitis vs discitis

A

Osteomyelitis is found in the vertebrae and possibility IDVs

Discitis is ONLY IVDs

Both are likely if patient has lower back pain, UTI and fever combo.

Can both form an epidural abscess overtime

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8
Q

Spinal stenosis characteristics

A

Radiopathy

  • pain and paresthesia most common when walking vs sitting (psuedoclaudication)
  • older populations only

Usually treated conservatively treatment is best and only use laminectomy when needed

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9
Q

What is the more common site of back pain?

A

Lumbar/lower back pain

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10
Q

Risk factors for neck pain

A

Women

Family genetics

Poor psych health

Tobacco use

Occupation use

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11
Q

Back pain most common age range

A

40-60

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12
Q

Risk factors for low back pain

A

Obesity

Genetic factors

Sedentary lifestyle

Occupation

Being >40 years

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13
Q

Nexus low risk criteria for neck

A

No posterior midline cervical spine tenderness

No intoxication

Normal alter ness

No focal neurological defects

No painful distracting injury

  • if all criteria is met, there is no need for an X-ray (imaging)
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14
Q

Radicular symptoms of neck/back pain are most seen in what nerve roots?

A

C7: upper limb

L5/S1: Lower limb

Due to transition zones at these points

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15
Q

Subacute and chronic spinal back pain top 4 causes

A

OA

Spinal Stenosis

Spondylolisthesis

Scoliosis

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16
Q

Acute lower and upper back/neck pain top causes

A

Muscle strain

Whiplash

Herniated nucleus pulposus

17
Q

Different types of herniated discs

A

Middle into spinal canal: bilateral anesthesia and radiopathy symptoms

Bilateral into nerve root: Unilateral anesthesia and radiopathy symptoms

18
Q

Cauda equina syndrome

A

Compression of multiple lumbrosacral nerve roots caused by herniated disc, spinal stenosis, infection or trauma.

Symptoms:

  • low back pain w/ unilateral or bilateral sciatica
  • bladder/bowel dysfunction
  • sexual dysfunction
  • decreased perineal sensation
  • Saddle anesthesia

Treatment: surgery

19
Q

Spondylosis

A

Acquired Degenerative disorder of the vertebral spine and discs

Symptoms:

  • Osteophytes are present
  • ligamentous hypertrophy
  • Facet Joint arthropathy
  • vertebral subluxation of vertebrae forward or backward
20
Q

Lumbar spinal stenosis

A

Narrowing of the lumbar spinal foramen along lumbar vertbrae

  • often caused by spondylosis and spondylolisthesis*

Symptoms:

  • back pain (unilateral or bilateral)
  • pain or numbness when walking
  • improves when sitting, bending forward
  • > 40 years of age

Treatment:

  • NSAIDs and PT or OMT
  • if very stenosis, then surgery
21
Q

Spondylolysis

A

Stress fractures that are non-displaced along the pars interarticularis of the vertebrae.

Causes =. Degenerative bone diseases in elderly. Repetitive hyperextension or rotation in younger patients

MOST COMMON SITE IS L5

Symptoms:

  • positive storks test
  • insidious onset of deep back pain and worsens w/ extension

Treatment:

  • requires oblique xrays (if negative, do MRI or CT)
  • Brace, core rehabilitation
  • acetaminophen if no liver issues
  • calcium and Vit D supplements
22
Q

Spondylolisthesis

A

Slippage of a vertebral body usually resulting after spondylolysis

Grade system:

1: 0-25% slippage
2: 26-50% slippage
3: 51-75% slippage
4: 76-100% slippage

Treatment:
Surgery

23
Q

Straight leg raise test (Lasegue)

A

Tests for sciatic nerve compression

Patient is supine or seated and the leg is raised why the knee remains extended

(+) supine = pain radiating down leg when hip is flexed @ 30-60 degrees unilaterally

(+) seated = patient leans back away from pain when leg is flexed @ 30-60 degrees unilaterally

  • if bilateral, may be Cauda equina involvement/ central disc herniation
  • Note: can experience pain at 70 degrees, however this is more indicative of a stretch muscle or joint pain in SI/ lumbar facet joints*
24
Q

Spurlings maneuver

A

Cervical compression test that tries to reproduce radiopathy signs. Lean patient one way and Compress cervical spine that direction

(+) pain on concave Side = nerve compression
(+) pain on convex side = muscle strain (reverse spurlings)

  • contraindicated in patients w/ present or possible cervical spine injuries *
25
Q

Most common subtype of neck/back pain

A

Acute >3 months

26
Q

L4 L5 and S1 reflexes

A

Patellar tendon

Medial hamstring

Achilles’ tendon

27
Q

S1 weakness in gait

A

Can’t walk on toes

28
Q

L5 weakness in gait

A

Foot drop

29
Q

Transverse myeitis

A

Most commonly associated with Multiple Sclorosis and opticmeyloitis

Symptoms:

  • inflammation present w/ TNF IL-1/6
  • lumbar puncture will show elevated CSF and leukocytes
  • bilateral motor and neurological dysfunction
  • always have symptoms associated with affected spinal level

Multiple spots appear opaque in the spinal cord itself and always have abnormal bilateral numbness/paralysis

Requires early treatment to treat best
- usually with steroids

30
Q

Is rest usually good for back pain

A

Not really. Can be used but wont treat

Musculoskeleton (36 decks)

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