Back pain Flashcards
What are the non-MSK differentials for back pain?
- Cauda equina
- Malignancy
- Pyelonephritis
- Leaking AAA
- Peptic ulcer
What are the clinical features of musculoskeletal/mechanical back pain?
- Acute onset
- In paraspinal muscles, not central
- Normal spine and neurological exam
How do you manage musculoskeletal/mechanical back pain?
- NSAIDs + PPI
- Education warn about RFs
- Return to normal activities without bed rest
- Avoid precipitants
- Physiotherapy and advised to mobilise
What are the clinical features of sciatica?
- Unilateral leg pain radiating below the knee to the foot/toes
- Low back pain (Less severe than leg pain)
- Paraesthesia and muscle weakness in dermatome (L4-S3)
What are the clinical signs on examination of sciatica?
- +ve straight leg test
* Extensor plantar response
What is likely to be the cause of sciatica <50yrs and >60yrs?
<50yrs = disc herniations >60yrs = spinal stenosis
How do you manage sciatica?
Neuropathic pain:
• amitriptyline, duloxetine, gabapentin or pregabalin
What is ankylosing spondylitis?
Inflammatory condition mainly affecting the sacroiliac joints
What are the clinical features of ankylosing spondylitis?
- <40yrs
- Lower back pain
- Night pain not relieved in a supine position
- Stiffness in the morning that is relieved with exercise
- Gradual onset
- Symptoms >3 months
What are the examination findings of ankylosing spondylitis?
- Reduced lateral flexion
- Reduced forward flexion (Schober’s test)
- Reduced chest expansion
What are the x-ray findings of ankylosing spondylitis?
o Bamboo spine
o Squaring of vertebral bodies
o Subchondral sclerosis
o Syndesmophytes
o Ossification of the ligaments, discs and joints
o Fusion of facet, sacroiliac and costovertebral joints
What are the associations with ankylosing spondylitis?
The A’s • Apical fibrosis • Anterior uveitis • Aortic regurgitation • Achilles tendonitis • AV node block • Amyloidosis • And cauda equina syndrome
What are the clinical features of spinal stenosis?
- Gradual onset
- Intermittent Unilateral or bilateral leg or lower back pain, numbness and weakness which is worse on walking
- Relieved by sitting down, leaning forwards or crouching
What are the primary and secondary causes of an iliopsoas abscess?
Primary
o Haematogenous spread of bacteria
o Staphylococcus aureus
Secondary o Crohn’s o Diverticulitis, CRC o UTI o Vertebral osteomyelitis o Endocarditis o IVDU
What are the features of an iliopsoas abscess?
- Fever
- Back/flank pain
- Limp
- Weight loss
