Back Injuries Flashcards
Are most spine complaints life threatening??
NO! Most have non-specific etiology WITHOUT life threatening complications
What is important to look for when asking for the history from a patient with a back complaint?
Look for concerning risk factors
Back pain for less than 6 weeks
Acute
Back pain for 6-12 weeks
Sub-acute
Back pain for greater than 12 weeks
Chronic
Night pain (esp. that wakes the patient up), unrelenting pain, pain worsened by cough or valsalva, pain with ANY neurologic deficit
Back pain that raises alarm for concern
What 3 neurologic components should you test in the physical exam on a patient with a back pain complaint?
Strength, reflexes
Toe walking tests which nerve?
S1
Plantar flexion tests which nerve?
S1, S2
Heel walking tests which nerve?
L5
Squat and rise tests which nerve?
L4
Achilles reflex is which nerve?
S1
Patellar reflex is which nerve?
L3-L4
Should you get labs on a patient with back complaints?
Nah
Best imaging for back pain and gold standard for suspected infection, neoplasm, or compression syndromes of the spine?
MRI
CT is good for ??
Vertebral fractures
Treatment for non-specific back pain?
Ibuprofen or Tylenol, muscle relaxants, SHORT TERM opioids
Should your recommend activity or bed rest to people with back pain?
ACTIVITY!
Think of this in a patient who complains of radicular back pain
Sciatica
SLR and crossed SLR is positive in a person with?
Sciatica
How do you treat sciatica?
Conservatively if there are no risk factors and neurologic compromise
Pai is worse with standing and extension, relieved with rest and flexion; Pseudoclaudication in leg
Spinal stenosis
How do you confirm a diagnosis of spinal stenosis?
CT or MRI
How do you treat spinal stenosis?
Same as non-specific back pain, refer to spinal surgeon
If a patient has spinal cord compression, cauda equina syndrome, conus medullaris syndrome what do you do before diagnostic testing?
10mg dexamethasone IV before diagnostic texting
If you suspect a spine tumor what should you get?
MRI
Gold standard for diagnosing a spinal infection?
MRI
