Back Pain

Question 1

define mechanical back pain

Answer 1

recurrent and relapsing and remitting back pain with no neurological symptoms
usually worse with movement and relieved by rest

Question 2

treatment of mechanical back pain

Answer 2

analgesia and physiotherapy

Question 3

where does an acute disc tear occur

Answer 3

annulus fibrosis of the intervertebral disc

Question 4

characteristic feature of discogenic back pain

Answer 4

worse on coughing

Question 5

most common site for disc prolapse/herniation causing impingement

Answer 5

L4/L5/S1 nerve roots

Question 6

Features of L3/4 prolapse

Answer 6

L4 root entrapment

pain down to medial ankle, loss of quadricep power, reduced knee jerk

Question 7

features of L4/5 prolapse

Answer 7

L5 root entrapment

pain down dorsum of foot, reduced power of extensor hallucis longus and tibialis anterior

Question 8

features of L5/S1 prolapse

Answer 8

S1 root entrapment

pain to sole of foot, reduced power of plantarflexion, reduced ankle jerks

Question 9

spinal stenosis

Answer 9

spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis which means the cauda equina of the lumbar spine has less space

Question 10

consequence of spinal stenosis

Answer 10

claudication

Question 11

features of spinal claudication

Answer 11

inconsistent claudication distance
pain is burning rather than cramping
tends to be better walking uphill and cycling is easy
pain is relieved by flexion

Question 12

features of cauda equina syndrome

Answer 12

bilateral leg pain, paraesthesia/numbness and complain of saddle anaesthesia
altered urine and bowel function may also occur

Question 13

Ix in cauda equina syndrome

Answer 13

PR
urgent MRI
urgent discectomy

Question 14

red flags of back pain

Answer 14

younger patient or new onset pain in older pain
pain is severe, constant or worse at night
systemic upset

Question 15

features of osteoporotic crush fracture

Answer 15

acute pain and kyphosis

Question 16

features of cervical spondylosis

Answer 16

slow onset stiffness and pain in the neck radiating to shoulders and occiput

Question 17

2 conditions where atraumatic instability of the cervical spine may occur

Answer 17

Down’s syndrome

rheumatoid arthritis

Question 18

why does atlanto-axial subluxation occur in RA?

Answer 18

destruction of synovial joint between atlas and dens and rupture of the transverse ligament

Question 19

assessment of myotome L1/2

Answer 19

hip flexion

ask the patient to push up against your hand

Question 20

assessment of myotome L3/4

Answer 20

knee extension

ask patient to straighten their knee against your hand

Question 21

assessment of myotome L5

Answer 21

foot dorsiflexion and extensor hallucis longus

extension or dorsiflexion of the foot and more specifically, extension of the great toe

Question 22

assessment of myotome S1/2

Answer 22

ankle plantarflexion

Question 23

sciatica

Answer 23

buttock/leg pain in a specific dermatomal distribution accompanied by neurological disturbance

Question 24

features of discogenic pain

Answer 24

segmental instability 
worse as day goes on 
worse on flexion 
worse with activity 
deep seated central low back pain

Question 25

features of facet arthropathy

Answer 25

stiff in the morning 
restless 
difficulty sitting, driving, standing 
worse with exertion 
better with activity 
often radiates to buttocks and legs