Back pain Flashcards
What are the red flags for back pain
Age <18 or >55 with new onset back pain
Trauma
Unexplained weight loss
Neurological symptoms - bilateral sciatica, saddle anaesthesia
Atypical Pain - thoracic Pain, pain at night
Fever, sweats and rigors
Incontinence - faecal and urinary, trouble passing urine (prostate cancer)
Steroid or drug abuse
Hx of cancer
What are some causes of painful back
Trauma - fractures, sprains
Autoimmune - RA, Ankylosing Spondylitis, Polymyalgia Rheumatica, OA (spondylosis), Septic arthritis
Metabolic - Osteomalacia
Referred pain - OA of hip, tumour of hip, Sciatica caused be piriformis syndrome
Neoplasm: Tumour
Degenerative: herniated disc
What are the yellow flags
Attitude Depression/anxiety Fear avoidance behaviour Expectation that passive rather than active treatment will be beneficial Social or financial issues
What is cauda equine syndrome
Impingement of the cauda equina (end of the spinal cord)
it is a medical emergency
What are the signs on clinical examination of cauda equina syndrome
Parathesia in the saddle region
Lower motor neurone signs - weakness, fasciculations, muscle wasting, hyporeflexia
What are the symptoms of cauda equina syndrome
Numbness around groin
urinary and faecal incontinence
lower back pain spreading down one or both legs
What are the causes of cauda equina syndrome
herniation of lumbar disc
tumours or mets
Trauma
infection - discitis
congenital: spina bifida, kyphoscoliosis, congenital spinal stenosis
Spondylolysis (deformities in the vertebral arch)
Spondylolisthesis (vertebra slips out of place)
Late stage anylosing spondylitis
What are the causes of spinal stenosis
Osteophytes Hypertrophy of ligamentum flavum Patients are at higher risk if they have - hyperparathyroidism - pagets disease of the bone - Ankylosing Spondylitis - Cushings Syndrome - Acromegaly
