Back pain Flashcards
Key symptoms in cauda equina
Saddle anaesthesia
Bladder / bowel incontinence (new onset)
Leg weakness
Numbness / tingling in legs
Malignancy key questions
Weight loss
Loss of appetite
Fever
Night sweats
Red flags in back pain
Age <20 or >50 Pain at night Pain on lying flay Thoracic back pain Cauda equina symptoms Alcohol / drug use B symptoms Hx of cancer Significant trauma
Bed side tests in back pain
If suspect cauda equina - PR exam
Urinalysis - ? pyelnonephritis
Blood tests in back pain
FBC CRP / ESR U&Es LFTs Calcium and phosphate Bence jones and Ig - tes for myeloma
Blood cultures - if suspect osteomyelitis
Imaging options
Plain x-ray - suspect OA / minor disc narrowing
MR - soft tissue
Bone scan - suspect malignancy
After what age does mechanical back pain rarely present?
60+
define disc prolapse
when a part of nucleus pulpos herniates onto annulus fibrosis
Usual age of disc herniation presentation
35 - 55 y/o
Medication hx important to elicit in back pain hx
long term steroid use
Neurological bilateral claudication ->
spinal stenosis
Those predisposed to osteomyelitis
IV drug user
Immunosuppressed
