Back Pain

Question 1

10 ‘Red Flags’ in back pain:

Answer 1

Age >70

Osteoporosis
Malignancy
Immunosuppression

Steroids
IVDU

Unintentional weight loss
Fever

> 6 weeks, or worsening
Nocturnal pain

Neuro deficit

Question 2

Which lower limb findings constitute ‘hard’ signs vs non-concerning radiculopathy:

Answer 2

Radiculopathy may have mild pain-limited weakness. Reflexes intact. May have light-touch paraesthesia in 1-2 dermatomes, but ‘special’ sensory is normal. Shooting neuropathic pain.

Significant or non-pain-limited weakness
Depressed reflexes
Paraesthesia with loss of:
- 2 point
- Sharp/dull
- Temp
- Proprio

Question 3

Differentials for back pain

Answer 3

MECHANICAL
- Soft tissue
- Fracture
- Tumour/ mets
- Spinal cord compression/ cauda equina
- Paget’s

INFECTIVE
- Osteomyelitis
- Discitis
- Epidural abscess

INFLAMMATORY
- Ankylosing spondylitis (<30, wake stiff)
- Inflammatory arthritis’ (psoriatic, gono, RA)

NON-SPINAL
- AAA/ dissection
- Retroperitoneal haemorrhage
- Renal colic
- Pancreatitis
- PUD
- Sickle crisis
- Pregnancy Cx
- Shingles