Back pain Flashcards
spondylosis
umbrella term for different forms of age-related degeneration of the spine
spinal stenosis
narrowing of the spaces in your spine, can compress your spinal cord and nerve roots exiting each vertebrae
spondylolysis
stress fracture through the pars interarticularis of the lumbar vertebrae
spondylolisthesis
a bone (vertebrae) in the spine moves forward out of the proper position onto the bone below it
causes of acute LBP
lifting, twisting avoid BLT- bend lift twist mva slip and fall injuries weekend warrior
what not to miss for LBP
cauda equina fx cancer progressive neurological symptoms AAA (abdominal aortic aneurysm) spinal abscess (fever + back pain)
SIJ vs facet pain
SIJ= 1 Facet= 2
Sacroiliac joint formed by
formed by the connection of the right and left iliac bones to the sacrum
reinforced by strong ligaments
not much motion
What can SIJ mimic and why?
sciatic pain- piriformis syndrome
sits on top of sciatic nerve
SIJ dysfunction results from and involves what
injury
hypomobility of joint
SIJ dysfunction physical exam tests
patricks/fabers - stresses the sij
leg length measurement- looking for hypomobility- gold= xray and measure
forward bend and march test- looking for hypomobility
What would you find on physical exam for sij dysfunction?
leaning to one side while sitting
tenderness over affected sij and piriformis m
limited rom in no or all planes in L/S
hypomobility of joint
forward test is looking for
affected SIJ to raise
match test is looking for
affected SIJ to drop
Facet joint
small, stabilizing joint that prevents the spine from translating anteriorly
slide upon each joint surface and have tiny nerve innervations- Rhizotomy kills the nerve
Facet syndrome usually includes
paraspinous muscular involvement (spasm)
Facet syndrome presentation
flexion= open= better extension= worst
vague, dull back pain tenderness over facet joints tight hamstrings excessive lordotic curve truncal obesity lordosis of pregnancy
what contributes to facet pain and why?
arthritis
due to joints that are small and constantly in motion
facet pain test
quadrant/kemps test “facet loading”
discogenic pain
bulging disk
Herniated disc
who is predisposed to disc injury?
repetitive lifting, pulling, pushing, bending sideways and twisting smokers exposure to vibration prolonged sitting static posture weak core strength
common complaints with discogenic pain
hurts when I sneeze, cough, bear down, laugh pain w l/s flexion, relief laying down radicular pain/paresthesia back pain muscle spasm pain with prolonged sitting
physical exam findings with discogenic pain
still ambulation pain with positional changes paresthesias in dermatomal pattern weakness in myotomal pattern \+ SLR decreased DTR paraspinous muscle spasm
acute lbp non surgical management
NSAIDS
opioids
topamax
imaging for back pain is not recommended in the first ___ unless
6 weeks
red flags are present
Right sided low back pain and possibleinjections. She reports achy, burning right sided low back pain that radiates to the right posterior leg, knee, calf with numbing in the 4th and 5th toes.She denies weakness or loss of sensation in the lower extremities. The pain lasts all day and is worst in the evening. Ice, diclofenac and gabapentin, stretching all help the pain. Standing, sitting or bending worsen the pain. She has difficulty sleeping due to pain. She is only able to sit, stand or drive for 15 minutes due to pain.She did fall skiing 5 months ago tearing her left ACL. She believes the change in her gait and caring for her mother with Parkinson’s has aggravated her back pain.Symptoms interfere with: daily activity, sleep and any bending. Prior episodes of this problem: Similar pain 2015 treated with TF ESI with good result. she does report some chronic right sided low back pain but the pain radiating to her leg is recent.
bulge
2-3 years of achy and stabbing low back pain that intermittently worsens after nonspecific activity. He has constant low-grade pain that is worst in the morning and last 8-12 hours a day. He also has episodes of severe low back pain approximately once a month. He feels he cannot straighten due to something “stuck” in his back. When he is able to straighten, he has severe low back pain for 2-3 days. He denies weakness, loss of sensation or radiating pain to his lower extremities. Advil and rest help his pain. Bending, twisting, and walking all worsen his pain. He is unable to load to the dishwasher because the twisting and straightening of his spine aggravatehis pain. He is able to sit and most comfortable driving his work truck.
facet
Severe tight low back pain that radiates to his posterior legs and ankles whenever he stands or walks. He denies weakness or loss of sensation in the lower extremities. He has no pain sitting down and is only able to walk or stand for 3-4 minutes before he must sit back down due to severe pain. The pain started gradually 2 years ago and has been consistent.Symptoms interfere with: daily activity, cooking, and all mobility. MedicationGabapentin with some mild relief.
discogenic
Left side low back pain that feels like a “hot needle” in his back. The pain does not radiate to the buttock or lower extremities. He denies weakness or loss of sensation in the lower extremities. The pain is constant and worst in the am upon arising from bed. Lying down helps the pain. Any movement or activity worsens the pain, he also wakes in the night due to pain. His activity is severely limited due to pain. The pain started 2 months ago after a trip to Texas which included lots of walking, fishing, lifting suitcases and dragging suitcases through the airport.
facet
