Back pain Flashcards
What are some red flag symptoms with back pain?
Non-mechanical pain
Systemic upset
New neurological deficit
Saddle anaesthesia +/- bladder/bowel upset.
Name the myotome responsible for hip flexion
L1/2
Name the myotome responsible for knee extension
L3/4
Name the myotome responsible for EHL and foot dorsiflexion
L5
How does sciatica present?
Buttock or leg pain in a specific dermatomal distribution with neurological disturbance
How can disc prolapse present?
Episodic back pain
Onset of leg pain
Leg pain becomes dominant
Specific myotome and dermatome presentation
When does disc prolapse become an emergency?
If involving cauda equina
What is adjacent segment disease?
The vertebrae next to the affected disc is then affected too.
Describe mechanical back pain
Recurrent and relapsing back pain with no neurological symptoms.
Worse on movement and relieved by rest.
What are causes of mechanical back pain?
Obesity, poor posture, poor lifting technique, facet joint OA.
What is the treatment for mechanical back pain?
Analgesia and physiotherapy.
Why is bed rest not recommended as a treatment for mechanical back pain?
May lead to stiffness and spasm.
What are the yellow flags involved in mechanical back pain?
Low mood
High levels of percieved pain
Job dissatisfaction
Belief that activity is harmful
What pathology is worse on coughing?
Acute disc tear
What is sciatica?
Herniation of nucleus pulposus on an exiting nerve root
Where is the commonest site for sciatica ?
L4,5 and S1
What is spinal stenosis?
Compression of multiple nerve roots, particularly in cauda equina
What symptoms can present with spinal stenosis?
Burning pain
Pain is less walking uphill
Reserved pedal pulses
Claudication distance is inconsistent
What is cauda equina syndrome?
Compression of all nerve roots at cauda equina caused by a very large central disc prolapse
Why is cauda equina a surgical emergency?
Sacral nerve roots compressed so can cause saddle anaesthesia.
Long term it can cause permanent nerve damage
A presentation of what symptoms must be considered as cauda equina?
Bilateral leg symptoms and any suggestion of altered bowel or bladder function
What tests are needed if cauda equina is suspected?
PR
MRI
What are some red flag symptoms in spinal conditions?
Back pain 60 yrs
Constant/severe/night pain
Systemic upset
What is a crush fracture?
Spontaneous crush of the vertebral body due to severe osteoporosis
What is spondylosis?
Degeneration of the intervertebral discs
What is spondylothesis?
A shift in a vertebrae
How might cervical spondylosis present?
Slow onset stiffness and pain in the neck which might radiate to the shoulders and occiput
How might a cervical disc prolapse present?
Shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes.
Which nerve roots are normally affected in cervical disc prolapse?
C7 or C8 root
What investigations can be carried out if a cervical disc prolapse is suspected?
MRI.
Findings should be co-ordinated with the clinical history.
When can cervical spine instability occur?
Down syndrome
RA
Why does cervical spine instability occur in RA?
Atlanto-axial subluxation due to destruction of the synovival joint between C1/C2
What is the danger with a cervical instability?
Subluxation which could lead to cord compression
