Back pain

Question 1

What are the red flags for malignancy in back pain?

Answer 1

Weight loss
Night pain 
Thoracic pain 
Night sweats 
Hx of cancer

Question 2

What are the red flags for cauda equina syndrome?

Answer 2

Weakness
Numbness
Saddle anaesthesia
Bowel or bladder involvement

Question 3

What other systems can cause back pain?

Answer 3

Urinary - pyelonephritis
Vascular - AAA
Gastro - peptic ulcer

Question 4

Which condition gives an abnormal Schober’s test?

Answer 4

Ankylosing spondylitis - reduced lumbar flexion

Question 5

What are the non-invasive treatments for low back pain and sciatica?

Answer 5

Education about red flags
Return to normal activities and avoid bed rest
Avoid precipitants
Physiotherapy

Question 6

What is sciatica?

Answer 6

Irritation of the sciatic nerve

Question 7

What can cause sciatica?

Answer 7

Disc herniation - under 50

Spinal stenosis - over 60

Question 8

What symptoms and signs are present in sciatica?

Answer 8

Pain shooting down legs
Positive straight leg raise
Neurological signs in specific nerve root distribution

Question 9

What can be used in the treatment of resistant lower back pain?

Answer 9

TENS - transcutaneous electrical nerve stimulation

Works via gate theory

Question 10

What are the steps in looking at a cervical spine image?

Answer 10

Adequacy/alignment
Bones
Cartilage
Dense soft tissues

Question 11

What should be checked for alignment in a lateral cervical spine image?

Answer 11

Anterior aspect of vertebral body - anterior longitudinal ligament
Posterior longitudinal ligament
Spino laminar line
Spinous process line