Back and neck Pain Flashcards
Back pain common epidemiology
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)
Acute vs chronic back pain
<6 week =acute
> 6 weeks chronic
TUNA FISH
Trauma
Unexplained weight loss
Neurological symptoms
Age greater than 50
Fever
IV Drug
Steroid use
History of cance
Claudia equina syndrome
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
Sciatic
Herniated IVD disc impinges sciatic nerve that causes lower extremity paralysis and muscle weakness
Spinal infections are most common from where?
Hematogenous spread via UTI
Osteomyelitis vs discitis
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
Spinal stenosis characteristics
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
What is the more common site of back pain?
Lumbar/lower back pain
Risk factors for neck pain
Women
Family genetics
Poor psych health
Tobacco use
Occupation use
Back pain most common age range
40-60
Risk factors for low back pain
Obesity
Genetic factors
Sedentary lifestyle
Occupation
Being >40 years
Nexus low risk criteria for neck
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)
Radicular symptoms of neck/back pain are most seen in what nerve roots?
C7: upper limb
L5/S1: Lower limb
Due to transition zones at these points
Subacute and chronic spinal back pain top 4 causes
OA
Spinal Stenosis
Spondylolisthesis
Scoliosis
Acute lower and upper back/neck pain top causes
Muscle strain
Whiplash
Herniated nucleus pulposus
Different types of herniated discs
Middle into spinal canal: bilateral anesthesia and radiopathy symptoms
Bilateral into nerve root: Unilateral anesthesia and radiopathy symptoms
Cauda equina syndrome
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
Spondylosis
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
Lumbar spinal stenosis
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
Spondylolysis
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
Spondylolisthesis
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
Straight leg raise test (Lasegue)
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*
Spurlings maneuver
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 *
Most common subtype of neck/back pain
Acute >3 months
L4 L5 and S1 reflexes
Patellar tendon
Medial hamstring
Achilles’ tendon
S1 weakness in gait
Can’t walk on toes
L5 weakness in gait
Foot drop
Transverse myeitis
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
Is rest usually good for back pain
Not really. Can be used but wont treat
