Back Pain Flashcards
What is persistent lower back pain?
defined as non-specific lower back pain that has lasted for more than 6 weeks.
What is a red flag sign?
Any symptom or demographic which indicates a potentially life threatening pathology
What is a yellow flag?
psychosocial factors indicative of long term chronicity and disability
Name 8 red flags for spinal pathology
- Thoracic pain
- Fever and unexplained weight loss
- Bladder or bowel dysfunction
- History of carcinoma
- Ill health or presence of other medical illness
- Progressive neurological deficit
- Disturbed gait, saddle anaesthesia
- Age of onset 55 years
Give five yellow flags for spinal pathology
- A negative attitude that back pain is harmful or potentially severely disabling
- Fear avoidance behaviour and reduced activity levels
- An expectation that passive, rather than active, treatment will be beneficial
- A tendency to depression, low morale, and social withdrawal
- Social or financial problems
What is the cauda equina?
The spinal cord terminates at L2/L3, branching into spinal nerve roots and nerves (L2-5, S1-S5, coccygeal nerve). An intervertebral disc herniation at this level can lead to Cauda Equina Syndrome which presents with a multitude of symptoms including incontinence and impotence.
What is cauda equina syndrome?
Cauda Equina Syndrome is caused by compression of the nerves, causing one or more of the following: bladder and/or bowel dysfunction, reduced sensation in the saddle area, and sexual dysfunction, with possible neurological deficit in the lower limb.
Give five causes of cauda equina syndrome?
- Herniation of a lumbar disc (L4/L5 or L5/S1)
- Tumours – metastases, lymphomas, spinal tumours
- Trauma
- Epidural abscess
- Congenital
What are the main examination thingies for spinal pathology? (7 years)
- Reduced range of spinal movement
- Reduced straight leg raise
- Positive neural stretch tests
- Neurological deficit (sensory, motor, reflex and impairment)
- Distribution of paraesthesias or sensory loss
- Reduced ankle and great toe dorsiflexion
- Knee and ankle reflexes
How do you treat spinal pathology with no red flags?
Five pooiints
- Paracetamol or non-steroidal anti-inflammatory drugs is usually effective
- Consider adjunct management with manipulation of the lumbar spine or physiotherapy is indicated
- Cold or warm compresses may help
- Encourage a prompt return to work
- If yellow flags are present assess for signs of depression
What is an upper motor neurone?
An UMN is a motor efferent fibres, with a cell body in the motor region of the cerebral cortex or brainstem, which remain within the CNS and synapse with lower motor neurones.
Give some symptoms of UMN disease?
- Hypertonia
• Loss of descending inhibition - Hyperreflexia
• Loss of descending inhibition - Spastic paralysis
• Loss of descending inhibition - Clasp-knife reflex
• Increased tone gives resistance to movement, but when sufficient force is applied resistance suddenly decreases - Clonus
• Loss of descending inhibition leads to self re-excitation of hyperactive reflexes - +’ve Babinski sign
• Scrape along lateral edge of foot and in towards great toe
• Dorsiflexion of hallux, extension/flaring of toes (Loss of descending inhibition means the reflex is unable to be suppressed) - Choreoforms (Spontaneous, unwanted movements)
What is a lower motor neurone?
A LMN is a somatic motor efferent fibre, with a cell body in either Lamina IX of the spinal cord (spinal motorneurone) or Cranial Nerve Motor Nucleus (cranial motorneurone).
Give some symptoms of lower motor neurone disease?
- Hypotonia (or Atonia) o Lack of LMN means muscle cannot contract to produce tone - Hyporeflexia (or Areflexia) o Loss of LMN componenet of reflex arc - Denervation muscle atrophy - Fasiculations o Spontaneous depolarisation in muscle - Paralysis - Muscle Weakness - Muscle Wasting
What is a nerve root impingement
A nerve is impinged at or near its root, shortly after its exit from the spinal cord.
