Back Pain Flashcards
What are red flags of back pain
Acute tearing back pain duration >6 weeks fever neurologic deficit’s night pain unexplained weight loss chronic steroid use IV drug use significant trauma Loss of bowel/urine control
What are emergent back pain diagnosis
Cauda equina syndrome Spondylolysis Spondylolisthesis Herniated disc Compression fracture Spinal stenosis
When should you image a patient with back pain
Long-term pain
whipping mechanism like in an MVA
direct trauma
What are some special test he might perform when evaluating back pain
Straight leg raise (L4/5, S1)
Neuro: sensations, DTR, rectal exam (S5)
Motor: heel walk (L4/5), toe walk (S1)
If a patient has a herniated disc at L3 to L4 for what sensory loss will they have what motor weakness well they have what is the screening exam what reflex would you perform
L4 Medial foot knee extension squat and raise patellar
If a patient has a herniated disc at L4-L5 for what sensory loss will they have what motor weakness well they have what is the screening exam what reflex would you perform
L5 dorsal foot dorsiflexion ankle/great toe heel walking no reflex test
If a patient has a herniated disc at L5-S1for what sensory loss will they have what motor weakness well they have what is the screening exam what reflex would you perform
S1 lateral foot plantar flexion ankle/toes walking on toes Achilles reflex
____ Is where in tear in the age of the spine
Spondylosis
___ is The defect or stress fracture in the pars interarticularis
Spondylolysis
What is usually the cause of spondylolysis
Repetitive hypertension
What are signs and symptoms of Spondylolysis
Back pain worse with extension and hyperextension
Deep palpation elicits pain
What x-ray sign will you see with a patient with spondylolysis
Scotty collar fracture
What is the treatment for spondylolysis
Conservative rest lordotic racing external bone stimulator PT
___ is slippage if the vertebrae
Spondylolisthesis
What are signs and symptoms of spondylolisthesis
Back pain worse with extension hyperextension
neuro signs plus dural tension
maybe evident during single leg raise
Step off on palpation
What can you see on x-ray in a patient with spondylolithesis
Vertebral body slipped forward
What is the treatment for spondylolisthesis
Rest
Bracing
PT
surgery if severe
— is a systemic rheumatic dz w/ chronic inflammation that causes arthropathy of the Skelton and SI joints w/ progressive stiffness
Ankylosing spondylitis
What are signs and symptoms of ankylosing spondylitis
Back pain and stiffness
skin issues
IBS
anterior uveitis
Loss of ROM
What will you see on the x-ray of a patient with ankylosing spondylitis
Bamboo sign
What labs should you order when working up a patient with Ankylosing spondylitis
HLA – B 27 genotype
CRP
ESR
rheumatoid factor
What is the treatment of a patient with Ankylosingspondylitis
PT
NSAIDs
TNF alpha blockers (infliximab)
referred to rheumatology
____ is compression of the cauda equina
Cauda equina syndrome
What are signs and symptoms of cauda equina syndrome
Severe low back pain new onset about and bladder incontinence sciatica saddle anesthesia weakness and numbness
What PE things you need to do to work up a patient with cauda equina syndrome
Straight leg raise
digital rectal exam
strength testing
DTRs
What imaging do you need to work on the patient with cauda equina syndrome
Stat MRI
What is the treatment for cauda equina syndrome
Emergent surgical decompression
What is the other name for disc herniation
A cute lumbosacral radiculopathy
What are physical exam findings in a patient with acute lumbosacral ridiculopathy
Radiating back pain to lower extremities
usually from L5 S1 spinal nerve roots
What kind of imaging do you need to work on the patient with disc herniation
None
What is the treatment for disc herniation
NSAIDs
Flexeril
tramadol
Refer to PT
Active rest
