Back Pain Flashcards
What associated symptoms should you enquire about in a back pain history?
Cord compression symptoms
Inflammatory symptoms
Constitutional symptoms
What questions may you ask when exploring associated feature of cord compression?
Any problems with waterworks?
Numbness and tingling in legs or buttock?
Weakness in legs?
If a man
Problems with gaining an erection?
What PMH should you specifically enquire about?
Arthritis
TB
Osteoporosis
Previous cancer
What family history should you specifically enquire about?
Ankylosing spondylitis
Osteoporosis
What are the FIVE red flag symptoms of back pain?
Progressively worsening, NOT relieved by rest
Age > 50 or < 20
Urinary / faecal incontinence, saddle anaesthesia, leg weakness
History of malignancy; weight loss; fever
Trauma or low velocity trauma with known osteoporosis
Which type of cancers have a tendency to metastasise to the bone?
Multiple myeloma
Prostatic
Breast
What are the two common causes of cauda equina syndrome?
Malignancy
Infection
What are some of the risk factors for osteoporosis?
Premature menopause (<40 years old) Corticosteroid use Oral contraceptive Malabsorption Smoking Female sex Increasing age
How may back pain caused by malignancy present?
Gradual onset
Not relieved by rest
Weight loss
How may back pain caused by osteoporotic crush fracture present?
Sudden onset
Localised
Minimal trauma
How may back pain causes by an infection present?
Severe
Fever, night sweats
Systemically unwell
Past history of TB may suggest Pott’s disease.
How may back pain causes by spinal canal stenosis present?
Pain on exercise, prolonged standing, lumbar extension
Relieved by rest, sitting down, laying down or on lumbar flexion
Pain is intermittent and radiates down to the thighs and legs
What may patient say alleviates pain in spinal canal stenosis?
Stooped forwards position
What is spinal canal stenosis associated with and what population is it commonly seen in?
Degenerative changes
Therefore usually seen in the elderly
What are some non-spinal causes of back pain?
How may they present?
Aortic dissection - tearing pain between scapula
Fibromyalgia - generalised aches and pains, including arthralgia and myalgia
Pancreatitis
Endometriosis
Renal calculi
