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MSK > Back pain > Flashcards

Back pain Flashcards

1
Q

What are some red flag symptoms with back pain?

A

Non-mechanical pain
Systemic upset
New neurological deficit
Saddle anaesthesia +/- bladder/bowel upset.

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2
Q

Name the myotome responsible for hip flexion

A

L1/2

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3
Q

Name the myotome responsible for knee extension

A

L3/4

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4
Q

Name the myotome responsible for EHL and foot dorsiflexion

A

L5

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5
Q

How does sciatica present?

A

Buttock or leg pain in a specific dermatomal distribution with neurological disturbance

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6
Q

How can disc prolapse present?

A

Episodic back pain
Onset of leg pain
Leg pain becomes dominant
Specific myotome and dermatome presentation

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7
Q

When does disc prolapse become an emergency?

A

If involving cauda equina

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8
Q

What is adjacent segment disease?

A

The vertebrae next to the affected disc is then affected too.

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9
Q

Describe mechanical back pain

A

Recurrent and relapsing back pain with no neurological symptoms.
Worse on movement and relieved by rest.

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10
Q

What are causes of mechanical back pain?

A

Obesity, poor posture, poor lifting technique, facet joint OA.

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11
Q

What is the treatment for mechanical back pain?

A

Analgesia and physiotherapy.

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12
Q

Why is bed rest not recommended as a treatment for mechanical back pain?

A

May lead to stiffness and spasm.

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13
Q

What are the yellow flags involved in mechanical back pain?

A

Low mood
High levels of percieved pain
Job dissatisfaction
Belief that activity is harmful

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14
Q

What pathology is worse on coughing?

A

Acute disc tear

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15
Q

What is sciatica?

A

Herniation of nucleus pulposus on an exiting nerve root

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16
Q

Where is the commonest site for sciatica ?

A

L4,5 and S1

17
Q

What is spinal stenosis?

A

Compression of multiple nerve roots, particularly in cauda equina

18
Q

What symptoms can present with spinal stenosis?

A

Burning pain
Pain is less walking uphill
Reserved pedal pulses
Claudication distance is inconsistent

19
Q

What is cauda equina syndrome?

A

Compression of all nerve roots at cauda equina caused by a very large central disc prolapse

20
Q

Why is cauda equina a surgical emergency?

A

Sacral nerve roots compressed so can cause saddle anaesthesia.
Long term it can cause permanent nerve damage

21
Q

A presentation of what symptoms must be considered as cauda equina?

A

Bilateral leg symptoms and any suggestion of altered bowel or bladder function

22
Q

What tests are needed if cauda equina is suspected?

A

PR

MRI

23
Q

What are some red flag symptoms in spinal conditions?

A

Back pain 60 yrs
Constant/severe/night pain
Systemic upset

24
Q

What is a crush fracture?

A

Spontaneous crush of the vertebral body due to severe osteoporosis

25
Q

What is spondylosis?

A

Degeneration of the intervertebral discs

26
Q

What is spondylothesis?

A

A shift in a vertebrae

27
Q

How might cervical spondylosis present?

A

Slow onset stiffness and pain in the neck which might radiate to the shoulders and occiput

28
Q

How might a cervical disc prolapse present?

A

Shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes.

29
Q

Which nerve roots are normally affected in cervical disc prolapse?

A

C7 or C8 root

30
Q

What investigations can be carried out if a cervical disc prolapse is suspected?

A

MRI.

Findings should be co-ordinated with the clinical history.

31
Q

When can cervical spine instability occur?

A

Down syndrome

RA

32
Q

Why does cervical spine instability occur in RA?

A

Atlanto-axial subluxation due to destruction of the synovival joint between C1/C2

33
Q

What is the danger with a cervical instability?

A

Subluxation which could lead to cord compression

MSK (30 decks)

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