Back pain Flashcards
name 6 differentials for back pain
- pyelonephritis
- cauda equina syndrome
- disc prolapse
- leaking AAA
- peptic ulcer disease
- malignancy
characteristics of cauda equina syndrome
- bilateral leg weakness
- reduced/absent reflexes
- numbness/paraesthesia
- saddle anaesthesia: buttocks, inner thighs, perineum
why is cauda equina a surgical emergency?
if untreated can lead to permanent loss of bladder and bowel function
what does MSCC stand for and when should the coordinator be contacted?
Metastatic spinal cord compression coordinator
contacted within 24 hours if a patient presents with development of progressive pain or other symptoms suggestive of spinal metastases
5 symptoms suggestive of spinal metastases
1) Unrelenting lumbar back pain
2) Thoracic or cervical back pain
3) Nocturnal back pain affecting sleep
4) Pain exacerbated by increased pressure: coughing, sneezing, straining
5) Associated with localised tenderness
non pharmacological management of mechanical back pain
- self management: information + encouragement with daily activities
- exercise: group exercise programmes
- avoid precipitants and bed rest
- physiotherapy and advised to mobilise
when do 90% patients recover from lower back pain
within 4 months
what is manual therapy for mechanical back pain
spinal manipulation and mobilisation or soft tissue techniques e.g. massage
name a management of resistant lumbar back pain
TENS = transcutaneous electrical nerve stimulation
name 3 bone disorders that can cause back pain
spinal stenosis
pagets disease
osteoporosis
what is the clinical presentation of sciatica?
sharp shooting pain from buttocks down to the toes of one side, not improving with pain killers, positive straight leg raise test
when is sciatic pain worse?
when sitting
what are the nerve roots of the sciatic nerve?
L4 - S3
name a cause of sciatica that can be treated with laminectomy
lumbar spinal stenosis
what is the most common level of a lumbar intervertebral disc prolapse?
L4/L5 and L5/S1
