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Y2 MSK > Back Pain > Flashcards

Back Pain Flashcards

1
Q

What are the three clasifications of spinal functions

A

Locomotor, bony armour, neurological

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2
Q

What are the locomotor functions of the spine?

A

Capable of being both rigid and mobile

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3
Q

What are the bony armour functions of the spine?

A

Protection of the spinal cord

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4
Q

What are the neurological functions of the spine?

A

Spinal cord transmission of signals between brain and periphery

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5
Q

How many vertebrae make up the spine and of which type?

A

24 overall
7 cervical, 12 thoracic and 5 lumbar

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6
Q

What is the function of intervertebral disks?

A

Shock absorbers, allow segmentation and multi-directional movement

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7
Q

What are facets joints?

A

Small synovial joints at posterior spinal column linking each vertebrae

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8
Q

What are the key neurological structures in the spine?

A

Spinal cord, nerve roots, cauda equine

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9
Q

Where does the spinal cord end?

A

L2 vertebrae

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10
Q

Where is a lumbar puncture performed and why?

A

Performed at L3/4 space to avoid spinal cord

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11
Q

What are the three types of spinal movement?

A

Flexion/extension
Lateral flexion
Rotation

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12
Q

After how many weeks is back pain classified as chronic?

A

12 weeks

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13
Q

What are the four common causes of mechanical back pain?

A

Muscular tension
Acute muscle sprain/spasm
Degenerative disc disease
Osteoarthritis of facet joints

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14
Q

What is the first thing to distinguish when assessing back pain?

A

Mechanical back pain from serious pathology

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15
Q

What is mechanical back pain defining feature?

A

Worsens with movement, better or not present at rest

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16
Q

What term describes the pain radiating down one leg that often accompanies back pain?

A

Sciatica

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17
Q

What is the most probable cause of sciatica?

A

A disc herniation contacting the exiting lumbar nerve root

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18
Q

What are the 5 more serious causes of back pain?

A

Tumour, infection, inflammatory spondyloarthropathy, fracture, large disc prolapse (cauda equina)

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19
Q

What tumours are often found that cause back pain?

A

Metastatic cancer or myeloma

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20
Q

What infection can cause serious back pain?

A

Discitis, vertebral osteomyelitis, paraspinal absess, microbiology (staph, strep, TB)

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21
Q

What are the three most common types of inflammatory spondyloarthropathy that result in back pain?

A

ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease (IBD)-associated

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22
Q

How does a large disc prolapse result in back pain?

A

Causes neurological compromise

23
Q

What are the red flag symptoms of back pain?

A

Pain at night or increased pain when supine
-Constant or progressive pain
-Thoracic pain
-Weight loss
-Previous malignancy
-Fever/night sweats
-Immunosuppressed
-Bladder or bowel disturbance (Sphincter dysfunction)
-Leg weakness or sensory loss
-Age <20 or >55 yrs

24
Q

How is a history regarding back pain taken?

A

Site & pattern
•Character (e.g. aching, throbbing, burning, electricity)
•Onset
•Prolonged morning stiffness
•Exacerbating/relieving factors
•Effect of movement vs. inactivity
•Radiation (e.g. sciatica)
•Buttock pain
•Leg weakness
•Sensory loss/paraesthesia
•Lower limb claudication

25
Q

Outline the process of examination of the spine

A

Look
•Feel
•Move
•Straight leg raise (SLR)
•Lower limb neurological exam
•General exam (signs of malignancy, AAA)

26
Q

Cauda equina syndrome if untreated can result in what?

A

Is a neurosurgical emergency, can result in permanent lower limb paralysis and incontinence

27
Q

When is an investigation for back pain required?

A

In the absence of red flags, investigation not required

28
Q

What is the line of treatment for low back pain without red flags?

A

Time, analgesia, avoiding bed rest, physiotherapy

29
Q

what analgesics are prescribed to treat lower back pain without red flags?

A

NSAIDs- ibuprofen, paracetamol, codeine

30
Q

What specific markers are looked at in a blood test for investigating back pain?

A

Erythrocyte sedimentation rate, CRP, Full blood count, alkaline phosphatase, calcium , PSA

31
Q

What abnormalities associated with Lower back pain would result in an increased ESR?

A

Myeloma, chronic inflammation, TB

32
Q

What abnormalities associated with lower back pain would result in an increased CRP?

A

Infection of inflammation

33
Q

What abnormalities associated with lower back pain would result in an increased ALP?

A

Bony metastases

34
Q

Which abnormalities associated with lower back pain would result in an increase in calcium levels?

A

May be increased in myeloma or with bony metyastases

35
Q

What abnormalities associated with lower back pain would result in an increase in PSA in the blood?

A

Prostate cancer with bony mets

36
Q

What is the strongest genetic risk factor for ankylosing spondylitis?

A

HLA-B27

37
Q

What type of MHC molecule is HLA-B27?

A

MCH type 1

38
Q

Which cytokine play an important role in the pathogenesis of ankylosing spondylitis?

A
39
Q

How does sacro-illiitis seen on an MRI?

A

White spots either side of sacro-iliac joint

40
Q

What is the line of management for ankylosing spondylitis?

A
  1. Physiotherapy
  2. Pharmacological - NSAIDs
  3. Biologics - anti-TNFalpha (infliximab)
41
Q

By what mechanism do NSAIDs treat ankylosing spondylitis?

A

Inhibit cylcooxygenase 1 and 2 so less prostaglandin formation

42
Q

How do nerve roots exit the spinal cord?

A

Bilaterally

43
Q

What is the cauda equina?

A

Nerve bundle

44
Q

Does flexion or extension of the back describe forward bend?

A

Flexion

45
Q

What are the common causes of mechanical back pain?

A

Muscular tension (poor posture, weak muscles)
Acute muscle sprain/ spasm
Degenerative disc disease
Osteoarthritis of facet joints

46
Q

Location of sciatica pain is determined by what?

A

Level of the herniated disc

47
Q

What are the signs and symptoms associated with cauda equina syndrome?

A

Saddle anaesthesia
Bladder or bowel incontinence
Loss of anal tone on PR
Bilateral sciatica

48
Q

What investigations are made for suspected cauda equina?

A

Urgent MRI lumbar spine

49
Q

What are the causes of cauda equina syndrome?

A

large disc herniation, bony mets, myeloma, TB, paraspinal abcess

50
Q

What is inflammatory spondyloarthritis SpA?

A

Group of immune-related inflammatory diseases - ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease

51
Q

Primarily what does inflammatory spondyloarthritis cause?

A

Inflammation of the spin (spondylitis) and sacro-iliac joints (sacro-iliitis)

52
Q

What are the four extra-articular manifestations of SpA? AAAA

A

Anterior uveitis (iritis) – ocular inflammation
Apical lung fibrosis
Aortitis/aortic regurgitation
Amyloidosis – due to chronically serum amyloid A (SAA) depositing in organs

53
Q

Ankylosing spondylitis is characterised by what?

A

Enthesitis (inflammation of the enthuses - sites where tendon and ligaments join to bone)

54
Q

What is the natural progression of untreated AS?

A

Spinal enthesitis
Bridging spyndesmophytes
Spinal fusion

Y2 MSK (5 decks)

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