Back Pain

Question 1

Most comm types

Answer 1

Simple Lumbosacral or mechanical 90%. Clear mech of inj, pain worse on movem. PK often work. Yng age.
Signs of N root pain (sciatic or neur symps).
Possible sinister feats (incontin, saddle anaes, wl, fever, sweats, increasing pain).

Question 2

Red flags

Answer 2

Over 55 or under 20
Systemic ill
Sev increasing pain
Hx of CA- low thresh for PSA test in men
IV drug use- groin injec can cause back abcess. 
Urin reten
Sig trauma

Question 3

Cauda equina synd

Emergency, immed ref

Answer 3

Gait disturb, leg motor weakness
Sphincter disturb, bowel disturb
Saddle anaes
Sex probs

Question 4

Yellow flags

Can incr intensity and durat of pain

Answer 4

Pych risk distress or dep
Fam hx chronic back pain
Work rel issues
Medico legal proceedings
-keele start back score

Question 5

Exam

Answer 5

Obs
Palpat- verteb, pelvic jnts, lumbar musc
Move- stabilise hips- flex/ext, rot, side.
SLR. Can incl femoral stretch test (flex ankle in SLR).
Leg power, sensat and reflexes.

Question 6

Mx

Answer 6

Reass and advice. Us resolve 3wk if mechanical.
Stay active but avoid lifting. Walking good.
Regular PK.
Mitigating facs.
Physio.
MDT (CBT, back school)

Question 7

Ix

Answer 7

Usually none.
Blood and urine- ESR, CRP, FBC, PSA.
XR gives v high rad so only if suspect lytic or mets or frac.
MRI- disc, soft tiss, N.