Back Pain

Question 1

Is there difference in the incidence of back pain between sedentary workers and physical laborers?

Answer 1

No - almost everyone will experience back pain at some point in their lives

Question 2

Does most back pain need treatment?

Answer 2

No - vast majority will resolve without intervention within 6 weeks

Question 3

WHat are 7 questions you should ask a patient with back pain?

Answer 3

Character and location of pain
Onset
Course
Relationship to work or activity
Exacerbating or relieving factors
Prior treatment
Litigation/Work Comp

Question 4

What is the most common cause of back pain in adults?

Answer 4

mechanical low back pain caused by muscle spasms

can also be facet joint inflammation or SI joint dysfunction

Question 5

Why is it sometimes hard to figure out how the back pain started?

Answer 5

Often the pain won’t develop until days after the inciting incident, so people don’t put 2 and 2 togehter

Question 6

WHat are some psycho-social modulators of low back pain?

Answer 6

Anxiety/Depression
Stress (home or work)
Litigation
Job Satisfaction
Other Secondary Gain
Co-morbidities
Smoking, Drug/alcohol
Lifestyle Issues

Question 7

What is the technical term for a “step off”? WHat is it?

Answer 7

Spondylolysthesis

it’s when one of the discs slides off over the top of the disc below it.

Question 8

What is the most important step in treatment for mechanical low back pain (and any back pain really)?

Answer 8

get them up and moving! the sooner they get back to their normal activities, the sooner their pain will improve

Question 9

In what population is prednisone more successful in?

Answer 9

older patients who have had back pain for at least 10 days.

Question 10

True or false: recurrence rate for mechanical LBP is low.

Answer 10

False!

62% will recur in 1 year and 80% will recur in 2 years

Question 11

What are the 3 potential causes of spinal stenosis?

Under what category do they all fall?

Answer 11

They are all degenerative disease….

facet arthrosis

spondylolisthesis

sacroilliac arthrosis

Question 12

What is stpinal stenosis in general?

Answer 12

It’s gradual narrowing of the spinal canal and/or neural foramina

You can get it from osteophyte formation, facet hypertrophy, bulging disks, and hypertrophy of the ligamentum flavum

Question 13

In spinal stenosis, the back pain will radiate where?

Answer 13

down the back of the leg to the ankles or feet

Question 14

In what position will the symptoms of spinal stenosis be worse?

Answer 14

erect posture (neurogenic claudication)

Question 15

What are some associated neurological symptoms that may present with spinal stenosis?

Answer 15

paresthesas and foot drop

Question 16

What is spondylolithesis usually cause by?

Answer 16

bilateral pars defects (stress fracture) which can be developmental, traumatic, degenerative or pathologic

Question 17

WHat are some physical exam findings you’d get with an acute disc herniation?

Answer 17

1. splinting - walking favoring to one side
2. with or without tenderness to palpation
3. positive straight leg raise (with contralateral leg too)
4. Motor/sensory function impairment

Question 18

What are two surgeries they can do for a herniated disc?

Answer 18

microdiscectomy where they go in an basically suck out the nucleus pulposus

fusion where they take the disc out and stick bone between the vertebral bodies and screw them together

Question 19

True or false:

those who have surgery for disc herniation do much better than those who don’t.

Answer 19

True and false in a way…

those hwo have surgery heal faster, but after 10 years there is virtually no difference between the two groups

Question 20

What are some causes of sciatica?

Answer 20

disc disease

spinal stenosis

piriformis entrapment

peripheral entrapment

neurogenic claudication

Question 21

What signs are used to tell if someone’s faking back pain?

Answer 21

Waddell’s signs

Question 22

What is the most common cause of back pain in children?

Answer 22

it’s almost never mechanical…

spondylolysis/spnylolisthesis

disdk disease

tumor

infection

rhematologic

visceral

psychosomatic (especially if parent with back pain)

Question 23

What group of kids is especially prone to sponylolysis/spondylolisthesis?

Answer 23

gymnasts

Question 24

How does a three phase bone scan work?

Answer 24

you inject them with a radioactive marker that will get incorporated into bone - a very sensitive way to look for stress fractures