Back injury Flashcards
second most reason that people seek care in the ED, second to URI?
back pain
back pain for how long is considered chronic?
over 12 weeks
if you want to test S1 and S2, what moves should you have the patient perform?
toe walking (S1), plantar flexion (S1, S2)
if you want to test L4 and L5, what moves should you have the patient perform?
dorsiflexion (L4, L5), heel walking (L5)
squat and rise tests which spinal nerve?
L4
achilles reflex tests which spinal nerve?
S1
patellar reflex tests which spinal nerve?
L3-L4
a positive SLR test is very sensitive for which back problem?
sciatica
for what three types of indications in back pain would you order an MRI?
1) infection
2) neoplasm
3) compression syndromes (ie. cauda equina)
when would a CT be appropriate when evaluating a patient’s back pain?
vertebral fractures (shows great detail of vertebral bodies)
poor imaging of spinal canal!
what percentage of disc herniations are symptomatic?
only 3 percent; be careful of patient’s adopting a “sick” mindset leading to a lifetime of pain management and disability
how do we treat non-specific MSK back pain?
NSAIDS, tylenol, muscle relaxants (flexeril)
activity!! no bed rest!
what will a patient with sciatica most likely complain of?
radicular leg pain
where do 95 percent of herniated discs occur?
L4-L5 or L5-S1
if your patient with sciatica has no risk factors or neuro compromise, how should you treat them?
conservatively! same as non-specific MSK pain
80 percent improve without surgical intervention
patient presents with pain that is aggravated with standing and extension, what jumps to the top of your DDX?
spinal stenosis
in what positions will a patient with spinal stenosis have relief of their pain?
flexion and rest
which type of back pain is correlated with pseudoclaudication (leg pain)?
spinal stenosis
how do we treat someone with spinal stenosis?
refer to spinal surgeon; in these cases there IS a benefit to surgery
if someone presents with neurological weakness in their leg, what is the best imaging test to order? what do you need to be sure to do first?
MRI!
give 10 mg dexamethasone IV first to reduce swelling
how do we treat compression syndromes (cauda equina, conus medullaris)?
surgery!
drain hematoma, drain abscess, radiate cancer, surgical fixation
when palpating an old lady’s spine, you notice vertebral step offs and pin-point tenderness at the level of L3…she doesn’t recall ever being injured. what’s the likely DX?
compression fracture
best imaging for compression fracture?
MRI but X-ray is usually good enough
in what population are spinal infections most prominent?
immunocompromised, diabetics, IVD, cancer, organ transplant, recent LP
