Back Pain Flashcards
What are the differen types of back pain?
Viscerogenic (abdomen) Spondylogenic (joints and muscles) Discogenic (IV disc) Neurogenic (nerve root) Psychoenic
What can cause viscerogenic pain?
Peptic ulcer disease Gallbladder Pancreas Renal Uterine/ ovarian Colonic AAA
What needs to be assessed in back pain?
SOCRATES
What type of pain is nerve root leg pain?
SCIATICA Dermatomal Sharp, shooting pain Goes below the knee to the foot and ankle Anatomical sensory/motor symptoms
What type of leg pain does referred leg pain from facet joints cause?
Non specific Dull pain Common in buttocks and thigh Never below knee Ill-defined sensory symptoms
What neurological symptoms will back pain cause?
Bowel and urinary incontinence Bilateral or unilateral leg symptoms Paraesthesia Numbness Weakness
What features are red flags in back pain?
Non-mechanical pain Thoracic pain PH - carcionoma, steroids, HIV Systemic upset Major, new neurological deficit Saddle anaesthesia +/- bladder or bowel upset
What spinal pathologies can cause back pain?
OA can cause wedge fractures
Tumours - primary myeloma or mets
Infection - destruction of vertebrae and pus
Ankylosing spondylitis
What cancers commonly metastasise to the spine?
Bad Boys Pee Through Kidneys
Breast, Bronchus, Prostate, Thyroid, Kidney
What are the different types of disc prolapse?
Prolapsed (still contained within the posterior ligament)
Extruded
Sequestrated
How can large vertebral canal cause back pain?
Stretched annulus/ posteiror long ligament
How can small vertebral canals cause back pain?
Root compression causes release of inflammatory mediators
Root pain and tension signs
Where will sacroiliac joint pain refer to?
Buttock, back of thighs and facet joints in spine
What is spondylolisthesis?
Spondylolisthesis is a slipping of vertebra that occurs, in most cases, at the base of the spine
What is spondylolysis?
Defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5)
What should be examined in a back pain exam?
Observation Range of movement Neruological assessment Nerve root irritation Distraction testing
What nerves allow for hip flexion?
L1/2
What nerves allow for knee extenion?
L3/4
What nerves allow for foot dorsiflexion?
L5
What nerves allow for ankle plantarflexion?
S1/2
What are the 2 nerve irritaion tests?
Sciatic stretch test
Femoral nerve test
What specialised investigations are used for back pain?
MRI - BUT BEWARE Diagnostic facet injection Contrast CT Provocation discography Selective nerve block
What is sciatica?
Buttock or leg pain in a specific dermatomal distribution accomapined by neurological distribution
What is the common presentations of disc prolapse?
Episodic back pain
Onset of leg pain
Myotomes and dermatomes
How is backache treated?
Short bed rest
Anti-inflammatory +/- muscle relaxant
Mobilise thereafter
Physical therapy
What are red flag symptoms point to cauda equina syndrome?
Dysfunction of baldder, bowel or sexual function
Sensory changes in saddle or perianal area
What reg flag symptoms point to discitis/ infection?
Sudden onset of acute spinal pain or suspicioud change in pattern, no history of trauma
Systemic signs; fever, high pulse
Night pain
All spinal movements grossly restricted by pain and spasm
What red flag symptoms point to an inflammatory spondyloarthropathy?
Morning stiffness and backache or multiple joint problems
Generally inwell
Associated skin rash, IBD, eye problems, urethritis, SIJ pain
What conditions should be referred to a spinal specialist?
Lumbar disc prolapse with uncomplicatied sciatica
Lumbar spinal stenosis
Mechanical back pain
What spinal conditions are emergencies?
Cauda equina syndrome
Fracture with deteriorating neurology
What should the x-ray show for a C spine?
Make sure shows C7/T1
Where are the most common thoracolumber injuries?
T12 or L1
In what ways can the spinal cord be involved in a pathology?
Size of spinal canal
Location of injury
Bone pinching
Contact pressure
What can cause a secondary cord damage?
Cord swelling Oedema Ischaemia Thrombosis of small vessels Venous obstruction
What is a complete cord injury?
Complete severing of spinal cord
What will cause a central cord injury?
Typical hyperextension injury
Arms worse than legs
Prognosis variable
What are the symptoms of a brown sequard injury?
Paralysis on ipsilateral side
Hypaesthesia on contralateral side
What symptoms will an anterior cord injury cause?
Motor loss
Loss of pain and temp sense
Deep touch, position and vibration preserves
What deformities can scoliosis cause?
Rotational component
Lateral bend component
Rib deformaties
Visceral abnormalities
What are the different types of scoliosis?
Congenital
Early onset idiopathic
Late onset idiopathic
Secondary
What causes a congenital scoliosis?
Imbalance in the number of growth plates and the greater the imbalance the worse the deformity
What is heuter-volkmann’s law?
Increased pressure across an epiphyseal plate inhibits growth
What can produce a secondary scoliosis?
Neuromuscular
Tumours
Spina Bifida
What are the non-operative managments of scoliosis?
Serial corrective casts
Bracing
Corrective exercises
Electrical simulation
What is kyphoysis?
Centre of gravity anterior to spine
Opposite of scoliosis
What are the yellow flags for chronic back pain?
Low mood High levels of pain Belief that activity is harmful Low educational level Obesity Problem with compensation Job dissatisfaction Light duties not avaliable at work Lots of lifting at work
