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CSI 1b > Back Pain > Flashcards

Back Pain Flashcards

1
Q

Causes of back pain (NHS website)

A

Pulled muscle/strain
Slipped disc
Sciatica
Ankylosing spondylitis

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2
Q

Treatments

A

Painkillers (ibuprofen)
Physiotherapy
Manual therapy
CBT
Surgery

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3
Q

What is somatotropic arrangement?

A

Different areas of the body correspond to different areas of the somatosensory cortex of the brain

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4
Q

What is affective neuroscience?

A

Stimulation of different parts of the brain causes different effects

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5
Q

What can stimulation of the cingulate gyrus cause?

A

Aversion

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6
Q

What can stimulation of the insula cortex cause?

A

Vasoconstriction
Sweating
Increased pulse rate

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7
Q

What can stimulation of the amygdala cause?

A

Fear

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8
Q

What can stimulation of the reticular formation cause?

A

Arousal

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9
Q

Path of action potential for fine touch?

A

Sensory neurone via dorsal column-> medulla oblongata (decussation) via medial leminiscus-> thalamus -> sensory cortex

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10
Q

2 spinothalamic tracts?

A

Fast, sharp, a-delta fibres, often external pain and very precise (myelinated)

Slow, dull, C fibres, often internal pain

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11
Q

Fast spinothalamic tract route?

A

Receptor -> dorsal horn, decussates in spinal cord -> thalamus -> sensory cortex

Also connected to S II region (affects vision) and insula region (so causes vasoconstriction, sweating and increased pulse rate)

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12
Q

Slow spinothalamic route?

A

Receptor -> dorsal región (vía paleothalamic tract) -> decussates at spinal cord -> past reticular formation -> sensory + cingulate + amygdala
reticular - arousal
amygdala - fear
cingulate - aversion

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13
Q

Look at different brain regions mapped out

A

!!

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14
Q

Dorsal column sensations?

A

Fine touch, pressure, proprioception

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15
Q

Anterolateral column sensations?

A

Pain, temperature, light touch

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16
Q

Possible causes of medial posterior back pain?

A
  1. Vertebrae
  2. Spinal cord
  3. Nerve roots
  4. Lumbar muscles (e.g. erector spinae)
  5. Aorta
  6. Kidneys
  7. Pancreas
17
Q

Science of referred pain?

A

Organs/viscera can synapse near skin dermatomes

18
Q

At what level does the spinal cord end as an adult?

A

L1

19
Q

How do spinal nerves get to the spinal cord if they are lower than L1?

A

Via the cauda equina

20
Q

Radiculation?

A

Often due to disc herniation compressing spinal nerve
Unilateral

21
Q

Cauda equina syndrome

A

L4/L5 and L5/S1 most common sites of nerve compression in CES
Disc herniation compressing cauda equina

22
Q

Red flag symptoms of cauda equina syndrome?

A

Bilateral sciatica
Severe or progressive bilateral neurological deficit of legs (e.g. major motor weakness with knee extension, ankle eversion, or foot dorsiflexion
Difficulty initiating micturition or impaired sensation of urinary flow
Loss of sensation of rectal fullness
Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia)
Laxity of anal sphincter
Erectile dysfunction

23
Q

Sympathetic nerves also known as?

A

Thoracolumbar (T1-L2)
cauda equina syndrome only affects below this level, so sympathetic activity will not be affected by the condition

24
Q

Parasympathetic nerves also known as?

A

Craniosacral
CES can affect these levels, so PNS functions (like micturition and sexual function) can be affected by the condition

25
Q

Sympathetic nervous system effect on bladder?

A

Relaxes detrusor muscle (so it can fill)
Contracts internal urethral sphincter (so urine cannot leave)

26
Q

PNS effect on bladder?

A

Pelvic nerve from S2, 3 + 4
Contracts detrusor (so pushes out urine)
Relaxes urethral sphincter (so allows urine to leave)

sensory info also lost so unaware when need to urinate

27
Q

Voluntary control of micturition

A

Pudendal nerve (supplying external sphincter) can also be affected by CES

28
Q

Rare causes of CES?

A

Tumour
Infection

29
Q

What is breach of duty?

A

the care provided by the doctor fell below a reasonable standard

30
Q

What is causation?

A

the breach has caused loss or damage

31
Q

Red flag symptoms legally

A

Pain that radiates below the knees bilaterally (on rare occasions this can be unilateral).
Bilateral lower limb numbness or weakness.
Numbness either side of the buttocks and saddle area.
Bladder and/or bowel disturbance (including difficulty passing urine, poor stream, loss of sensation).
Erectile dysfunction.
Loss of anal tone or impaired sensation on per rectal (PR) examination.

32
Q

If no red flags, legally:

A

Make a record in the notes
Give safety net advice

CSI 1b (8 decks)

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