Back Lecture Flashcards
MC MSK complaint in ER
MC cause of work related disability in persons under 45 yo
Back pain
Which level is…
toe walking
S1
Which level is..
plantarflexion
S1, S2
What level is..
Heel walking
L5
What level is..
Dorsiflexion
L4
What level is…
Squat and rise
L4
What level is..
Achilles reflex
S1
What level is..
Patellar reflex
L3-L4
1-3% of back pain
may complain about radicular pain (leg pain)
*pos straight leg raise ~80% sensitive
*pos crossed straight leg raise highly specific, but not very sensitive
Sciatica
For sciatica, 95% of herniations occur at…
L4-L5 or L5-S1
Tx of sciatica if no other risk factors/neuro compromise
tx conservatively
**80% will improve without surgery, 50% within 6 weeks
Symptoms present during 6th decade of life
pain is worse with standing and extension, relieved with rest and flexion
Spinal stenosis
T or F…
Spinal stenosis can cause leg pain (pseudoclaudication)
True!
*refer these pts to a spinal surgeon
Spinal cord compression, cauda equina, conus medullaris syndrome
..these are all example of?
compression syndromes
(you treat all of them the same)
Compression syndromes may be caused by….
Tumors
Infection
Massive disc herniation
Tx= 10mg dexamethasone IV before diagnostic testing
Compression syndrome
If you are suspecting a tumor as the cause of compression syndrome, what image should you get?
MRI of entire spine
Spinal infections can be seen in…
Immunocompromised
DM
IVD
Cancer
Organ transplant
Recent LP
Fever seen in 50%
Vertebral body tenderness to percussion
Spinal infection
Plain films are helpful in..
Vertebral osteomyelitis
Gold standard image for spinal infections?
MRI
Tx for spinal infections?
Long term IV then PO abx
