Back Pain Flashcards
How is pain communicated to the pain?
Mechanoreceptros
Spinothalamic tract
Fast route for sharp pain - Adelta fibres
Slow route for dull pain - C fibres. Travels via reticular formation, amygdala and cingulate cortex
Synapse at dorsal horn and decussate
Third neurone begins at thalamus
What could be causing lower back pain?
Vertebra
Spinal cord
Nerve roots
Lumbar muscles
Referred pain:
Aorta
Kidneys
Pancreas
What is radiculopathy?
Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve.
Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy).
What is cauda equina syndrome?
Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.
What is mechanical back pain?
Mechanical pain is the general term that refers to any type of back pain caused by placing abnormal stress and strain on muscles of the vertebral column. Typically, mechanical pain results from bad habits, such as poor posture, poorly-designed seating, and incorrect bending and lifting motions.
What is radiculopathy?
Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve.
Unilateral symptoms
Most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy)
If the spinal body is damaged, what happens?
Multiple symptoms in multiple spinal roots
What causes radiculopathy?
Nucleus pulpous herniates posteriorly and laterally
‘Slipped disc’
Affects spinal root
What is sciatica?
Describes radiculopahty of the scatic nerve
Shooting pain down the back of one leg
What causes cauda equina?
Compression of the cauda equina that begins at L1/L2 level of spinal column
Most commonly due to disc herniates posteriorly and centrally you get bilateral symptoms
Infection
Tumor
What does Paul have?
Cauda Equina Syndrome
What are the most common sites of nerve compression in CES?
L4/L5
L5/S1
What are symptoms of CES?
Bilateral symptoms Bladder retention Bilateral leg weakness Change in bladder function Reduced perineurial function (thighs, anus) Sexual dysfunction Anal tension
What are the next steps with cauda equina?
Urgent MRI
Discussion with neurosurgeon
Need operating on within 24 hours of symptom onset
Why did Paul have back pain for years and then a more sudden onset?
Cauda equina is indeed an acute issue. However, the size of the disc herniation required to actually compress the cauda equina is quite large. As a result, many patients start off with a small disc bulge with associated symptoms- e.g radiculopathy. However, the disc herniation can become bigger either gradually over time or suddenly which leads to cauda equina syndrome
What is the difference between cauda equina and radiculopathy?
radiculopathy - often chronic slowly progressive managed usually conservative and on occasions mini-invasive surgery dependent on signs/symptoms/pain intensity
cauda Equina - large block of nerves affected , acute (or acute on chronic) presentation and an EMERGENCY as affecting crtical nerves S234 - pelvic/bladder nerves
What is the progression of urinary function in cauda equina?
Changes in urination
Urinary intention
Overflow incontinence - pressure
What are the red flag symptoms for cauda equina?
Saddle numbness Sexual dysfunction Urinary retention Bilateral sciatica Neurological deficit of the legs Loss of anal tone or impaired sensation on rectal examination
What are some neurological deficits of the legs?
Major motors weakness with knee extension
Ankle eversion
Foot dorsiflexion
What are the early warning signs for Cauda Equina syndrome?
Loss of feeling/pins and needles between inner thighs or gentials
Altered feeling when using toilet paper to wipe yourself
Increasing difficulty when trying to urinate
Increasing difficulty when you try to control flow of urine
Change in ability to achieve erection or ejaculate
Loss of sensation in genitals during sexual intercourse
What are some questions you can ask to diagnose cauda equina?
When was the last time you passed urine?
Have you noticed any changes when you have been intimate?
What must you do when someone comes in with back pain?
Tell them you think its mechanical back pain
But if they experience any of these symptoms they must see an doctor
Need to give them the relevant information
Where do surgeons make the incision in CES surgery?
Right over the area where the disc has herniated
What are pain receptors called?
Noiciception receptors
Embedded on the cell membranes on high threshold neurons
Found on plasma membrane
What causes muscle injuries?
Indirect or direct trauma
What is the difference between strain and sprain?
Strain is an injury to the muscle or musculotendinous junction, whereas sprain is an injury to the ligament
What are the causes of join swelling?
Infectious arthritis Immune-mediated arthritis Non-infectious and non-immune-mediated inflammatory arthritis Paraneoplastic arthritis Neoplastic arthritis.
What are differentials for an acutely swollen joint?
Septic arthritis Crystal arhropathies Osteoarthritis MSK injury Spondyloarthropathies e.g. reactive, psoriatic arthritis
What are differentials for muscle pain?
Medications e.g. statins Strain/Sprain Exertion Viral infections e.g. dengue Vascular
