Back Pain Flashcards
Back pain history
Age and occupation Pain history Timing and onset Parasthesia Motor disturbance Bladder/bowel symptoms Systemic symptoms
Red flags
<22y >55y Violent trauma Constant and progressive pain Night pain Thoracic pain Urinary incontinence/retention Worse when lying down PMH cancer Systemic steroids Drug abuse Wt loss Sever restriction in lumbar function Increasing neurology Structural deformity Saddle anaesthesia
Yellow flags
Chronic/ barriers to recovery Previous Days off Radiating leg pain Nerve root signs Decreased trunk strength Poor physical fitness Poor health Fear Depression Illness behaviour
Low job satisfaction Personal problems Smoking Benefits Medico legal
Simple/mechanical back pain epidemiology
2nd most common reason for seeing dr
>70% of pop
80% have at least 1 episode
Simple/mechanical back pain clinical features
20-55y Lumbosacral Varies with physical activity and posture Systemically well Unusual activity
Simple/mechanical back pain management
Education Maintain mobility Regular analgesia The back book Physio therapy Psychosocial factors 90% resolves within 6 weeks
Radiculopathy causes
Nerve root compression Prolapsed disc Spinal stenosis Cauda equina Facet arthrosis
Radiculopathy clinical features
LMN altered sensation in dermatome Reduced power in myotome Absent/ decreased reflex May progress to wasting Well localised pain
Radiculopathy management
Education Physio therapy Nerve root block Epidural steroid Foraminal steroid Surgical decompression
Prolapsed intervertebral disc pathology
Recurrent torsional strain -> annulus tears -> degeneration
Loss of elasticity and shock absorption
Herniation of nucleus pulposis
Laterally-> compresses nerve root
Centrally-> compresses spinal cord
Prolapsed intervertebral disc, lumbar, epidemiology
4-5th decade
m:f 3:1
5% symptomatic
Mostly commonly L5-S1
Prolapsed intervertebral disc, lumbar, clinical features and specific tests
Low back pain Radicular pain-> buttock and leg and lateral foot Worse sitting, better standing Worse when coughing Para spinous muscle spasm EHL, hip abduction and ankle plantar flexion weakness L5-S1 sensory loss Decreased ankle reflex
Pain and parasthesia on straight leg raise
Increased pain on lateral flexion
Prolapsed intervertebral disc, cervical, clinical features, specific tests
Occipital headache
Trapezial/intracapsular pain
Insidious onset
Unilateral arm pain, parasthesia and weakness
Spurlings test-> extension, rotation, lateral flexion and vertical compression together reproduce symptoms
Prolapsed intervertebral disc, management
MRI Analgesia TCA/gabapentin Rest Nerve root corticosteroids Surgical release
Cauda equina syndrome, causes
Disc herniation Spinal stenosis Tumour Trauma Epidural Haematoma Epidural abscess
Cauda equina syndrome, clinical features
Saddle anaesthesia Retention/incontinence Severe back pain Bilateral leg pain Impotence Leg motor loss Decreased sensation on PR
MRI and prompt decompression
Spinal stenosis pathology
Narrowing of the spinal canal and or foramina OA-> osteophytes Disc degeneration Ligament in flavum hypertrophy Usually >50y Males
Spinal stenosis, lateral recess, lumbar, clinical features
Descending nerve root compression Back and bilateral leg ache Worse on standing and walking and extension Relieved by sitting and forward flexion May be painful when lying down
Spinal stenosis, lateral recess, cervical, clinical features
LMN Neck and arm pain Parasthesia Weakened Decreased reflexes Spurligs sign-> lateral flexion
Spinal stenosis, central stenosis, lumbar, clinical features
LMN Neurogenic claudication Occurs at a reproducible distance Tight/heavy legs Radiates down legs from back Relieved by sitting and learning forwards Cycling and up hill are better
Spinal stenosis, investigations
X Ray
MRI
Spinal stenosis, management
Conservative
- oral medications
- physio
- analgesia
Surgical
- laminectomy
- central decompression
Cervical myelopathy, causes
Spinal cord compression
Direct cord compression -> cervical spondylosis
Ischaemia
Repeated osteophytes trauma
Cervical myelopathy, clinical features
Insidious onset
Pain free
LMN at level of lesion
UMN below
Weak and clumsy hand Unstable gait-> spastic Diffuse tingling and numbness Rarely urinary retention Clonus and up going plantar Hoffmann sign-> flick one distal phalanx and they all flex
Cervical myelopathy, investigations
X Ray
MRI
Cervical myelopathy, management
Conservative
- observation
- physio
- analgesia
Surgery
-decompression
Spondylosis definition
Morphological manifestation of degeneration of the spine
- loss of disc height
- disc fibrosis
- annular weakening
- osteophyte formation
Spondylolysis definition
Defect between the superior and inferior facets -> pars articularis
5th vertebra
Commonly incidental and asymptomatic
Spondylolisthesis definition and causes
Forward slipping of a vertebra on the one bellow
- result of spondylosis
- degenerative in elderly
- congenital
- traumatic
- pathogenic
Spondylolisthesis, adult isthmcic, clinical features
Due to spondylosis Long history of axial back pain Leg pain, usually L5 Muscle spasms Tight hamstrings Exaggerated lumbar lordosis Waddling gait Para spinous muscle spasm Neurogenic claudication Cause equina
Spondylolisthesis, degenerative, clinical features
L5/S1 Mechanical back pain Relieved by rest Leg pain Neurogenic claudication
Spondylolisthesis, investigations
X Ray
MRI
Spondylolisthesis, management
Conservative
- analgesia
- physio
- activity modification
- steroid injection
Surgery
-decompression and fusion
Facet dislocation, epidemiology, injury, clinical features
75% in sub axial spine
Flexion and distraction +- rotation-> ligament damage
Unilateral-> radiulopathy-> displaced spinous processes
Bilateral-> spinal cord injury-> stepping
Perch or locking
Scoliosis, definition, causes
Lateral curvature of the spine
Congenital
Idiopathic 80%
Neuromuscular
Scoliosis, clinical features
Uneven shoulders Prominent shoulder blades Uneven hips Poor posture One leg shorter than the others Adams test-> forward flex with straight legs
