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musculoskeletal > Back Pain > Flashcards

Back Pain Flashcards

1
Q

most common cause of vertebral osteomyelitis

A

staph. aureus

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2
Q

what is vertebral osteomyelitis

A

infection of the vertebrae

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3
Q

what may vertebral osteomyelitis be associated with

A

abscesses (epidural, psoas)

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4
Q

risk factors for vertebral osteomyelitis

A

PWID, poorly controlled diabetes, IV site infections, post operative

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5
Q

symptom of vertebral osteomyelitis

A

insidious onset of back pain (usually lumbar) which is constant and unremitting

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6
Q

clinical signs of vertebral osteomyelitis

A

paraspinal muscle spasm
spinal tenderness
may have fever
associated neurological deficit in severe cases

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7
Q

bloods in vertebral osteomyelitis

A

raised CRP

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8
Q

what is used to image vertebral osteomyelitis

A

MRI

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9
Q

what needs to be considered when investigating vertebral osteomyelitis

A

endocarditis

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10
Q

management of vertebral osteomyelitis

A

spinal stabilisation
high dose Abx after CT guided biopsy for cultures

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11
Q

when is surgery indicated for vertebral osteomyelitis

A

inability to obtain cultures by needle biopsy
no response to antibiotic therapy
progressive vertebral collapse
progressive neurological deficit

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12
Q

what is pott disease

A

vertebral body osteomyelitis and intervertebral discitis from tuberculosis

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13
Q

clinical presentation of symptomatic vertebral TB

A

slow and insidious
back pain
lower limb weakness
kyphotic deformity

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14
Q

imaging for vertebral TB

A

XR and MRI

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15
Q

when does mechanical back pain often present

A

20-55

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16
Q

name some risk factors for mechanical bone pain

A

obesity, poor posture, poor lifting technique, lack of physical activity

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17
Q

what is spondylosis

A

IV discs lose water content with age, resulting in less cushioning and increased pressure on the facet joint

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18
Q

what can spondylosis lead to

A

secondary OA

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19
Q

clinical presentation of mechanical back pain

A

pain in lumbosacral region, bum and thighs

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20
Q

management of mechanical back pain

A

restrict rather than avoid activity
lose weight
NSAIDs
physio

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21
Q

what usually causes an acute disc tear

A

lifting a heavy object

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22
Q

where does an acute disc tear occur

A

in the outer fibrosis of an intervertebral disc

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23
Q

symptom of acute disc tear

A

pain worse on coughing

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24
Q

imaging for acute disc tear

A

MRI

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25
Q

management of acute disc tear

A

analgesia and physiotherapy

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26
Q

what causes sciatica

A

compression of a nerve root

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27
Q

most common nerve root compressed in sciatica

A

L5/S1

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28
Q

what is the most common cause of sciatica

A

IV disc collapse

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29
Q

clinical presentation of sciatica

A

unilateral leg pain that is greater than in the back
sharp, shooting, electrical pain
radiates to the foot
numbness/paraesthesia

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30
Q

suppostive management of sciatica

A

NSAIDs and analgesia

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31
Q

what is spinal stenosis

A

narrowing of the central spinal canal

32
Q

what usually causes spinal stenosis

A

degenerative joint disease in middle age- elderly patients

33
Q

what is central stenosis

A

compression of all the nerve roots passing through

34
Q

what is lateral recess stenosis

A

compression of the transitioning nerve root

35
Q

what is foraminal stenosis

A

compression of the exiting nerve root

36
Q

clinical presentation of spinal stenosis

A

pain on walking (claudication)

37
Q

who usually presents with spinal claudication

A

> 60

38
Q

how does spinal claudication differ to vascular

A

burning pain rather than cramping
spinal extension exacerbates symptoms
reserved pedal pulses

39
Q

what causes spinal extension

A

standing or walking downhill

40
Q

investigation for spinal stenosis

A

MRI

41
Q

conservative management of spinal stenosis

A

analgesia, physio

42
Q

surgical management of spinal stenosis

A

decompression

43
Q

why does decompression help spinal stenosis

A

leaves more space for the cauda equina

44
Q

what is cauda equina syndrome

A

dysfunction of multiple lumbar and sacral nerve roots

45
Q

most common cause of cauda equina syndrome

A

large central lumbar disc herniation at the L4/L5 and L5/S1 level

46
Q

clinical presentation of cauda equina syndrome

A

bilateral leg pain
urinary retention, incontinence
saddle anaesthesia
widespread motor weakness in the legs

47
Q

clinical sign of cauda equina

A

loss of anal sphincter tone on PR exam

48
Q

investigation for cauda equina syndrome

A

urgent MRI
bladder scan

49
Q

management of cauda equina syndrome

A

urgent discectomy

50
Q

when is back pain chronic

A

> 3 months

51
Q

red flags for neck pain

A

headache
fever
stiffness

52
Q

red flags for back pain

A

neuro deficit
systemic features: fever, chills, night sweats
PWID
travel to countries with TB
trauma
osteoporosis
pain at rest/ at night

53
Q

how does cervical spondylosis present

A

slow onset stiffness and pain in the neck
can radiate to shoulders and the occiput

54
Q

management of cervical spondylosis

A

physio + analgesia

55
Q

complication of RA on the spine

A

atlanto-axial subluxation leading to chord compression

56
Q

conservative management of atlanto-axial subluxation

A

collar to prevent flexion

57
Q

surgical management of atlanto-axial subluxation

A

surgical fusion

58
Q

what is spondylolisthesis

A

anterior subluxation of one vertebra on another

59
Q

management of isthmic spondylolisthesis

A

decompression + fusion

60
Q

what is cervical radiculopathy

A

dysfunction of cervical nerve root

61
Q

name some causes of cervical radiculopathy

A

disc prolapse, vertebral osteophytes, compressive lesions e.g. tumours

62
Q

clinical presentation of cervical radiculopathy

A

pain radiating from the neck into the arm
numbness/weakness in the upper extremity

63
Q

investigation for cervical radiculopathy

A

MRI

64
Q

general management of cervical radiculopathy

A

analgesia + physio

65
Q

what is cervical myelopathy

A

dysfunction of the cervical spinal chord

66
Q

clinical presentation of cervical myopathy

A

slow, progressive symptoms
clumsiness of hands and feet
mild gait disturbances
paraesthesia

67
Q

surgical management of cervical myopathy

A

discectomy or laminectomy

68
Q

what is scoliosis

A

spinal deformity with sideways or coronal curve

69
Q

what is associated with scoliosis

A

vertebral rotation

70
Q

what are the 4 classifications of scoliosis

A

congenital
juvenile
adolescent idiopathic scoliosis
adult

71
Q

when is scoliosis classed as juvenile

A

<10 yrs

72
Q

when is scoliosis classed as adolescent

A

10-18 yrs

73
Q

clinical presentation of scoliosis

A

visible spinal deformity
pain
prominent rib hump, asymmetry of shoulders

74
Q

imaging for scoliosis

A

XR, MRI

75
Q

what is management of scoliosis based on

A

skeletal maturity, severity of deformation and progression of deformity

76
Q

what is kyphosis

A

spinal deformity with excessive convex curvature of the spine

77
Q

where in the spine is most commonly affected by kyphosis

A

thoracic spine

musculoskeletal (30 decks)

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