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MSK SB > Back Pain > Flashcards

Back Pain Flashcards

1
Q

what components contribute to back pain

A

biological
psychological
social

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2
Q

what should be included in the Hx of back pain

A 
onset
previous episodes
site and nature of pain
radiation of pain
neuro symptoms
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3
Q

red flags of back pain in history

A
  • Non – mechanical pain; pain that does not vary with activity
  • Systemic upset
  • Major, new, neurological deficit
  • Saddle anaesthesia (loss of feeling localised at the buttocks) +/- bladder or bowel upset
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4
Q

myotomes involved in - hip flexion, knee extension, foot dorsiflexion & EHL and ankle plantarflexion

A

Hip flexion - L1/2
Knee extension - L3/4
Foot dorsiflexion & EHL - L5
Ankle plantar flexion - S1/2

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5
Q

what is overt pain behaviour

A 
Guarding 
Bracing 
Rubbing 
Grimacing 
Sighing
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6
Q

what is mechanical back pain

A

recurrent relapsing and remitting back pain with no neuro symptoms.
worse with movement; relieved by rest

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7
Q

what can cause mechanical back pain

A 
obesity 
poor posture
lack of physical activity
degenerative disc prolapse
facet joint OA
spondylosis
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8
Q

what is spondylosis

A

disc degeneration leading to increased loading and accelerated OA of the facet joints

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9
Q

Tx for mechanical back pain

A

Analgesia

Physiotherapy

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10
Q

what can be done to test nerve irritation

A

straight leg test

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11
Q

what Ix is not advised in back pain

A

x-ray

- will see pathology related to age; red herring

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12
Q

main first line Ix for back pain

A

MRI

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13
Q

what is sciatica

A

Buttock and / or leg pain in a specific dermatomal distribution accompanied by neurological disturbance.

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14
Q

what is normal presentation of disc prolapse

A

variety of syndromes and presentations

leg pain and neurology important feature

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15
Q

when is surgery preformed in disc prolapse cases

A

for leg pain

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16
Q

what is common presentation of disc prolapse

A

Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dominant
Myotomes and dermatomes will tell you where the disc prolapse is

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17
Q

what is the Tx for disc prolapse

A

70% settle in 3 months
90% settle in 18-24 months
consider surgery after 3 months - open discectomy

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18
Q

Mx of Backache

A

short bed rest
anti-inflmmatory +/- muscle relaxant
mobilise
normal activity

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19
Q

what does backache often accompany

A

headache and tiredness

increased diagnosis of mental disorder

20
Q

why is surgery in back pain controversial

A

long term results (>5 years) are the same whether operated on or not

21
Q

what is the typical Hx of spinal claudication

A

Age 50 +
M > F
Heavy duty job
Obese

22
Q

symptoms spinal claudication presents with

A

Limited walking capacity
stoop/sit/lean forward to relieve symptoms
‘heavy’ or ‘tired’ legs

23
Q

how can spinal claudication be differentiated from vascular claudication

A

spinal

  • Relieved by flexing
  • Uphill often not bad
  • Cycling easy

vascular

  • relieved by standing
  • uphill bad
  • cycling bad
24
Q

what causes spinal claudication

A

spinal stenosis

25
Q

signs/symptoms of spinal stenosis

A

activity related back pain
previous back surgery
leg pain when walking
stooped posture when walking

26
Q

Ix for Spinal stenosis

A

MRI

27
Q

what causes discogenic back pain classically

A

lifting a heavy object (eg lawnmower).

28
Q

signs/symptoms of discogenic back pain

A

severe pain
segmental instability
worse as day goes on
worse on coughing

29
Q

Tx for discogenic back pain

A

symptoms usually resolve 2-3 months
Analgesia
Physiotherapy

30
Q

what is discogenic back pain also called

A

acute disc tear

31
Q

what is segmental instability pain

A

background ache, with exacerbations and remissions

central lower back pain

32
Q

how does Facet Arthropathy present

A 
Stiff  in  the  morning
“Loosen  up  routine”
“Restless”
Difficulty  sitting,  driving,  standing
Worse  with  extension
Better  with  activity
Often  radiates  to  buttocks  and  legs
33
Q

what are the red flags for back pain

A

Age less than 20 or more than 50 - first back pain
Non – mechanical, constant pain
History of cancer - particularly of any known to spread to bone
History of steroids
General malaise, fever, unexplained weight loss
Structural deformity
Saddle anaesthesia / paraesthesia +/- loss of bowel or bladder control
Severe pain longer than 6 weeks

34
Q

when taking an x-ray of the spine what must you ensure to image

A

C7/T1

35
Q

what is typical of a central cord injury

A

Typically hyperextension injury

Arms worse than legs

36
Q

what is typical of Brown-Sequard injury

A

Paralysis on ipsilateral side

Hypaesthesia on contralateral side

37
Q

what is typical of anterior cord injury

A

Motor loss
Loss of pain and temperature sense
Deep touch, position and vibration preserved

38
Q

when is surgery advised and when is it not is spinal cord injuries

A

complete cord lesion - not advised

incomplete cord lesion - controversial

39
Q

how is cervical spine damage managed

A

reduction with traction
Posterior approach for facet dislocation
Anterior approach for retropulsed fragments
Decompression and fusion + fixation

40
Q

what do thoracolumbar fractures often cause

A

complete paraplegia

41
Q

what can be done in thoracolumbar fractures with only partial cord damage

A

Decompression by anterior route
Transthoracic / retroperitoneal
Mechanically unstable fracture
Stabilisation

42
Q

what are sign/symptoms of cauda equina syndrome

A

Bowel or bladder dysfunction, bilateral sciatica, and saddle anaesthesia

43
Q

what can cause cauda equina

A

large central herniated disc or a pathological or traumatic fracture

44
Q

what is Heuter-Volkmann’s law

A

increased pressure across an epiphyseal plate inhibits growth

45
Q

what is scoliosis

A

lateral curvature of the spine

can be idiopathic or secondary to neuromuscular disease, tumour etc

46
Q

what is Spondylolisthesis

A

slippage of one vertebra over another and usually occurs at the L4/L5 or L5/S1 level

MSK SB (15 decks)

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