Back pain Flashcards
red flags for back pain
non-mechanical - worse at night, doesnt vary with activity - or constant pain Hx of cancer / steroids structural deformity >6wks of severe back pain new onset <20yo / >60yo systemics major and new neuro deficit saddle anaesthesia +/-bladder/bowel upset
< ___ is pathological stiffness on the Schobers test
<18cm
> ___ is hypermobile in Schobers test
> 24cm
foot dorsiflexion and EHL are supplied by which spinal nerve
L5
testing for nerve irritation by applying pressure behind the knee = ___ test
bowstring test
__% false +ve on MRI of prolapsed disc
76%
Sx for prolapsed disc is only for __ - doesnt help other symptoms
leg pain (just speeds up recovery - if left the outcome would be the same it would just take longer)
conservative Rx of disc prolapse =
bed rest > mobilise when can
anti-inflam +/- muscle relaxant
physio
behavioural symptoms of back pain
tip of coccyx pain whole leg pain/numb/gives way no pain free spells intolerance of Rx emergency admission
psychological yellow flags for back pain =
belief back pain is harmful
avoidance behaviour
low mood/withdrawal
passive not active
2ndry causes of scoliosis
neuromuscluar
tumour
spina bifida
in kyphosis centre of gravity is __ to spine
anterior
kyphosis is prominent in spina bifida due to _
erector spinae havent migrated posterior to the spine and so pull it forward
defect in pars interarticularis of vertebra
spondylolysis
forward slippage of 1 vertebra on another =
spondylolisthesis
complete slippage of 1 vertebra over another =
spondyloptosis
painless urinary retention with overflow is a sign of
cauda equina
causes of secondary spinal cord damage
cord swelling oedema ischaemia thrombosis venous obstruction
central spinal cord injury is typically due to a __ injury
__ worse than __
prognosis is good/bad
hyperextension
arms worse than legs
good
Brown-Sequard spinal cord injury =>
prognosis =
usually associated with a __
ipsilateral paralysis + contralateral hypoaesthesia
best prognosis of spinal cord injuries
#
anterior spinal cord injury features -
causes = __/__
prognosis =
motor+pain+ temp sensation loss
deep touch, position and vibration preserved
trauma/vascular causes
poor
Frankel/ASIA grading of spinal cord injuries
I/A > V/E
I = complete motor and sensory loss II = complete motor and incomplete sensory loss III = incomplete motor loss IV = useful motor and incomplete sensory loss V = normal
spinal damage in children may cause ___ which leads to cessation of growth and ___
ring epiphysis damage
kyphosis
rigid spine, long lever arms and soft porotic bone are features of
ank spond
In Ank spond the natural position of the C spine is usually ___ and so this is the position it is immobilised in
flexion
only MRI back pain if
red flags / considering Sx
spinal claudication age = M:F major factor = \_\_/\_\_\_ to relieve \_\_ is easy
>50yo F2:1M obesity lean forward/stoop cycling
xray of spinal claudication can sometimes show
v degenerative hypertrophic spine with narrow interpedicular distance and obliteration of neural foramena
pattern of discogenic pain
background and worse with activity + flexion
as day goes on = deep seated central low back pain
if severe discogenic pain can get ___ Sx
anterior fusion
features of facet arthropathy
stiff in morning restless difficulty sitting/driving/standing worse on extension better with activity radiation to buttocks and legs
Rx of facet arthropathy
excise facets and fuse
question mark spine =
sign of
loss of lumbar lordosis and exaggerated thoracic kyphosis
ankylosing spondylitis
treatment of PMR wo GCA
15mg prednisolone
in vertebrae___ lies inferior to pedicle
neural foramen
When to do CT for spinal trauma ?
xray normal but high clinical suspicion
xray shows # but need more detail/ to see if there are more
cant see IV ligaments on CT/xray but if ___ then can assume intact and spine is stable
normal spinal alignment
on MRI ligaments normally appear :
damaged =
norm = black damaged = light
MRI used for spinal injury if
need spinal lig detail
neuro deficit and cant see cause on CT/xray
signs of bone tumours seen on MRI
early = bone marrow infiltration late = extradural mass + spinal cord compression
signs of bone tumours seen on CT/xray
bone destruction (decreased density) sclerosis (increased density) vertebral collapse (pathological #)
MRI can show this precursor feature of disc prolapse
disc dehydration
spinal cord can only be seen on this imaging modality
MRI
