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Musculoskeletal > Back Pain > Flashcards

Back Pain Flashcards

1
Q

what are the red flags of back pain?

A

-pain in patient 60
-constant pain, pain that is worse at night
(ie non-mechanical pain)
-systemic upset
-major, new neurological deficit
-saddle anaesthesia +/-bladder/bowel upset
-PHx of cancer

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2
Q

what myotomes are in control of hip flexion?

A

L1/2

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3
Q

what myotomes are in control of knee extension?

A

L3/4

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4
Q

what myotomes are in control of foot dorsiflexion?

A

L5

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5
Q

what myotomes are in control of ankle plantarflexion?

A

S1/2

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6
Q

how do you test L1/2? (hip flexion)

A

push on anterior aspect of thigh and ask patient to push up against your hand

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7
Q

how do you test L3/4? (knee extension)

A

when knee is flexed, push on anterior aspect of leg and ask patient to straighten their knee against your hand

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8
Q

how do you test for superficial/ non-anatomical tenderness?

A

pinch the skin

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9
Q

what is axial loading testing?

A

applying pressure on the spine by pushing on head- this should not increase pain, but if patient says it does you need to consider psychosocial factors

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10
Q

what is sciatica?

A

buttock or leg pain caused by irritation of the sciatic nerve

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11
Q

what is the timing of back pain due to a disc prolapse?

A

episodic

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12
Q

what pain tends to become dominant over the back pain in a disc prolapse?

A

leg pain

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13
Q

when is a prolapsed disc an emergency?

A

if there are cauda equina symptoms/signs

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14
Q

when do you consider surgery for a disc prolapse?

A

if pain is not resolving after 3 months

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15
Q

why do you not immediately consider surgery for a disc prolapse?

A

long term results of conservative treatments are the same

most resolve on their own

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16
Q

what is adjacent segment disease?

A

symptomatic disease of the spinal segments adjacent to a fusion operation

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17
Q

what is cauda equina syndroma?

A

pressure or swelling on the nerves of the cauda equina, untreated can lead to paralysis

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18
Q

what are the 2 main initial symptoms of cauda equina syndrome?

A
  • various urinary upsets

- painless urinary retention with overflow

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19
Q

when taking an C-ray of the cervical spine what must you ensure the X-ray shows?

A

C7/T1

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20
Q

what does saddle sparing do to the diagnosis of complete cord injury?

A

no longer complete cord injury

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21
Q

what type of movements typically are more likely to have central cord injury?

A

hyperextension

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22
Q

what is Brown-Sequard syndrome?

A

damage to one side of the spinal cord causing paralysis on the ipsilateral side and hypaesthesia on the contralateral side

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23
Q

what is brown-sequard syndrome usually seen in?

A

trauma

ie fracture

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24
Q

what is anterior cord syndrome?

A

damage to the 2/3 anterior of the spinal cord causing motor loss, loss of pain and temperature but preservation of fine touch and proprioception

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25
Q

what is anterior cord syndrome usually seen in?

A

vascular supply problem

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26
Q

why in anterior cord syndrome are fine touch and proprioception preserved but pain and temperature are lost?

A

fine touch and proprioception are carried in posterior tracts

pain and temperature are carried in anterior/lateral tracts (which are damaged)

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27
Q

what is the benefit of a short segment fusion over a long segment fixation surgery?

A

in short fusion the implant doesn’t need to be removed

in long fixation the implant has to be removed after 1 year

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28
Q

what are the differences between spinal and vascular claudication in terms of what happens on standing?

A

vascular claudication is relieved by standing

spinal claudication is made worse

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29
Q

what are the differences between spinal and vascular claudication in terms of what happens on flexing?

A

spinal claudication is relieved by flexing

vacular claudication is not

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30
Q

what are the differences between spinal and vascular claudication in terms of what happens on walking up hill?

A

vascular claudication pain is worse on walking up hills

in spinal claudication pain might actually improve (due to flexed position)

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31
Q

what are the differences between spinal and vascular claudication in terms of cycling?

A

in spinal claudication cycling is easy (due to flexed position)

in vascular claudication all sport/exercise (like cycling) is difficult

32
Q

what kind of pain occurs with a patient with a degenerative disc?

A

aching, poorly-localised, central back pain- usually lower back
(discogenic pain)

33
Q

what happens to discogenic pain as the day goes on?

A

becomes worse

34
Q

what happens to discogenic pain on activity?

A

becomes worse

35
Q

how long does it take a patient with facet arthropathy to ‘loosen up# in the mornings?

A

about 20 minutes

36
Q

compare discogenic pain to facet arthropathy in terms of what movement make the pain worse?

A

facet arthropathy is worse with extension

discogenic pain is worse with flexion

37
Q

what is the surgical treatment of a prolapsed disc?

A

disectomy

38
Q

what is the surgical treatment of a disc degeneration?

A

interbody fusion

39
Q

what is the surgical treatment of spinal stenosis causing claudication?

A

root decompression and then stabilisation

40
Q

what is the surgical treatment of facet arthritis?

A

excision of facets and fusion

41
Q

what is mechanical back pain?

A

recurrent relapsing and remitting back pain with no neurological symptoms
(no red flag symptoms present)

42
Q

what exacerbated mechanical back pain?

A

movement

43
Q

what relieves mechanical back pain?

A

rest

44
Q

what age are patients typically when tehy present with mechanical back pain?

A

20-60 years ol

45
Q

what are the 8 main causes of mechanical back pain?

A
  • obesity
  • poor posture
  • poor lifting technique
  • lack of physical activity
  • depression
  • degenerative disc prolapse
  • facet joint OA
  • spondylosis
46
Q

what is spondylosis?

A

where the invertebral discs lose water content with age resulting in less cushioning and increased pressure on facet joints

47
Q

what can spondylosis commonly lead to?

A

facet joint OA (due to increased pressure)

48
Q

what is the mainstay of treatment for mechanical back pain?

A

analgesia and physiotherapy

49
Q

why should bed rest be avoided in patients with mechanical back pain?

A

will lead to stiffness and spasm of the back which may exacerbate disability

50
Q

what minority of patients with mechanical back pain can be considered for spinal stabilisation?

A

-single level (ie 2 adjacent vertebrae) affected by OA or instability
AND
-patient has not improved despite physio and conservative management

51
Q

what is vertebral instability?

A

excessive motion caused by degenerative disc

52
Q

how is vertebral instability typically diagnosed?

A

MRI

53
Q

what part of the invertebral disc is involved in an acute disc tear?

A

annulus fibrosis

54
Q

what is the classic activity that causes an acute disc tear?

A

lifting a heavy object

55
Q

what characteristically exacerbates the pain from an acute disc tear?

A

coughing

56
Q

what is the mainstay of treatment for an acute disc tear?

A

analgesia and physiotherapy

57
Q

what can happen to the nucleus polposis of an intervertebral disc after an acute disc tear?

A

it can herniate or prolapse through the tear

58
Q

what is the treatment of OA if the facet joints causing nerve root impingement?

A

surgical decompression with trimming of impinging osteophytes

59
Q

what is spinal stenosis?

A

when there is not enough space for the cauda equina so nerve roots become compressed/irritates

60
Q

compare spinal claudication to vascular claudication in terms of distance at which pain starts?

A

vascular- distance is consistent

spinal- distance is inconsistent

61
Q

compare spinal claudication to vacular claudication in terms of the type of pain?

A

vascular- cramping

spinal- burning

62
Q

why is the pain in spinal claudication less when walking uphill?

A

spine flexion creates more space for the cauda equina

63
Q

what is the first line treatment of spinal stenosis?

A

conservative treatment

with physio and weight loss

64
Q

when can decompression surgery be considered for a patient with spinal stenosis?

A

-if symptoms fail to improve with conservative treatment
AND
-if evidence of stenosis on MRI

65
Q

what is cauda equina syndrome?

A

a surgical emergency where a large disc prolapse compresses all the nerve roots of the cauda equina

66
Q

if a patient comes in with bilateral leg symptoms/signs and any suggestion of altered bladder/bowel function, what is this condition until proven otherwise?

A

cauda equina syndrome

67
Q

if you suspect cauda equina syndrome what are the 3 main necessary steps?

A
  • rectal examination
  • MRI
  • urgent discetomy
68
Q

what are the main symptoms/signs a spontaneous osteoporotic rush fracture can lead to?

A
  • acute pain
  • chronic pain (due to altered spinal mechanics)
  • kyphosis
69
Q

what is the managment of osteoporotic crush fractures?

A

conservative

70
Q

what is the new operative management of osteoporotic crush fractures?

A

balloon vertebroplasty

71
Q

what is the management for less severe cases of atlanto-axial subluxation?

A

treated with a collar to prevent flexion

72
Q

what is the management for more severe cases of atlanto-axial subluxation?

A

surgical fusion

73
Q

what are the 2 main conditions which are known for atraumatic cervical spine instability?

A

rheumatoid arthritis

down’s syndrome

74
Q

What are the 4 types of low back pain that make up the diagnostic triage?

A

simple back pain
nerve root pain
serious spinal
cauda equina syndrome

75
Q

describe the leg pain in a patient with nerve root pain?

A

unilateral leg pain which is greater than the back pain

also parasthesia in the same distribution

76
Q

compare the ages of simple back pain and serious spinal pathology?

A

simple back pain: 20-55

serious spinal pathology 55

77
Q

compare the timing of pain between simple back pain and serious spinal pathology?

A

simple- occurs during movement

serious spinal pathology- constant unremitting

Musculoskeletal (16 decks)

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