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MSK > Back Pain > Flashcards

Back Pain Flashcards

1
Q

what are the five categories of back pain

A 
viscerogenic
spondylogenic (originates in spinal chord and its associated structures)
discogenic  
neurogenic 
psychogenic
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2
Q

what are abdominal causes of back pain

A 
AAA
renal colic 
pancreatitis 
peptic ulcer disease
gallbladder
uterine/ovarian
colonic
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3
Q

describe root leg pain

A

dermatomal distribution, sharp, shooting, below knee, anatomical sensory and motor symptoms

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4
Q

what type of pain in sciatic

A

root pain

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5
Q

describe referred leg pain

A

down to back of knee- not below it, dull, gnawing, buttock, thigh, ill defined sensory symptoms

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6
Q

what are red flags of back pain

A

neurological- bowel/ urinary: incontinence, loss of control/ awareness. perineal/ saddle anaesthesia. bilateral/ unilateral/ no leg symptoms. paraesthesia, numbeness and weakness

no mechanical pain (doesnt vary with activity, worse at night

systemic upset

major, new, neurological deficit

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7
Q

what are 4 possible spine pathologys causing pain

A

fracture
tumour
infection
inflammatory conditions (e.g. AS)

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8
Q

what are the most common spine cancers

A

usually secondary

most common primary is myeloma

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9
Q

what cancers metastasise to bone

A

(bad little boys pee through kidneys)

breast, lungs, bronchus, prostate, thyroid, kidney

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10
Q

what are the local effects of spine infection

A

destruction of vertebrae, collection of pus

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11
Q

what condition most commonly predisposes spinal fractures

A

osteoporosis

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12
Q

what other feature might suggest cancer

A

weight loss, fatigue, anaemia, insidious onset of pain, night pain

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13
Q

what tends to cause nerve root problems

A

a protuding disc

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14
Q

what direction do discs usually protrude and what nerves do they affect

A

come out posterolaterally

affect traversing nerve (e.g. disc between L5 and S1 protrusion will affect nerve S1)

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15
Q

what can lead to a disc prolapse

A

impaired disc nutrition making it prone to damage by load, torsion, shear= disc fissure

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16
Q

what are the different types of disc prolapse

A

protrusion- prolapse contained by posterior ligament

extrusion- defect in annulus fribosus, usually not contained

sequestration- disc goes out into canal

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17
Q

what causes pain in a disc prolapse in the large vertebral canal

A

back pain from stretch annulus/ posterior long ligament

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18
Q

what causes pain in a disc prolapse when the vertebral canal in small

A

root compression, raised inflammatory markers,

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19
Q

what does loss of disc height (normal with ageing) cause

A

facet arthropathy (facet joints become maligned)= back pain +/- canal stenosis

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20
Q

what types of back pain can degenerative back pain cause

A

MBP- osteoarthritis, facet arthropathy

NRP- stenosis (osteophyte formation) or narrowing (loss of disc height)

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21
Q

what is the management for MBP

A

non surgical- physio

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22
Q

what is spondylolostheisis

A

when vertebrae slips forward onto bone beneath it (enabled by a fracture or defect)

23
Q

what is spondylolysis

A

stress fracture/ defect in the pars interarticularis of vertebral arch

24
Q

what do you look for in observation of the back and side in examination

A

deformity, asymmetry, hairy patches, neurofibromata, sometimes muscle spams

25
Q

name two things that can cause loss of lumbar lordosis

A

AS or spasm

26
Q

what will forward bending accentuate

A

structural deformity e.g. rib hump in scloliosis

27
Q

what classifies as pathologically stiff in schobers test

A

less than 18cm

28
Q

what problems might be exacerbated with hyperextension of spine

A

facet arthropathies

29
Q

What are the types of nerve irritation tests

A

straight leg raised + variants for sciatic nerve

femoral stretch for femoral roots

30
Q

what myotome for hip flexion

A

L1/2

31
Q

what myotome for knee extension

A

L3/4

32
Q

what myotome for foot dorsiflexion and extensor hallucis longus

A

L5

33
Q

what myotome for ankle plantarflexion

A

S1/2

34
Q

what does scaitic nerve irritation test

A

tight hamstrings
nerve irritation when you lift leg up straight with foot flexed and get a shooting pain radiating down the dermatome. drop leg until pain goes then dorsiflex foot and if pain comes back sciatic nerve irritation

35
Q

how do you do a femoral stretch

A

extend hip, flex the knee

36
Q

what is overt pain behaviour

A 
guarding 
bracing 
rubbing 
grimacing 
sighing
37
Q

what is a non anatomical pain

A

reflex behavioural response

38
Q

what is a straight leg raise distraction test useful for

A

people exaggerating their problem

39
Q

when should you do a rectal exam

A

spinal pathology or any possible suggestion of cauda equina syndrome

40
Q

what are the specialised spinal investigation

A

MRI (76% false positive)

diagnostic facet injection

contrast enhanced CT- myelogram

provocation discography

selective nerve block/ ablation

41
Q

what is a high intensity zone on MRI

A

white area- seen in e.g. annular tear

42
Q

what will a patient think sciatica is

A

vague buttock or leg pain

43
Q

what is sciatica

A

buttock and/ or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

44
Q

what is the surgery for a disc prolapse used to treat

A

leg pain not back pain

45
Q

what is the common presentation of a disc prolaspe

A

episodic back pain
onset of leg pain +/- neurology
leg pain becomes dominant
myotomes and dermatomes

46
Q

only when is a disc prolapse a surgical emergency

A

if there is cauda equina symptoms

most settle without surgery in 3-24 months

47
Q

what is the treatment for disc prolapse

A

conservative treatment, consider therapy if not resolving after 3 months

48
Q

what is the management for back ache

A

conservative treatment

  • short bed rest
  • anti inflammatory +/- muscle relaxant
  • mobilise thereafter (fast, acitve rehab)
  • physical therapies
  • x rays (only if severe)
  • return to normal activity

education
physio/osteopathy/chiropractic
TENS/ psychology/ pain clinic
surgery

49
Q

what are BAD managements of backache

A 
bed rest
bed rest with traction 
narcotics > 2 weeks 
benzodiazepines >2 weeks 
steroids
plaster jacket 
manipulation under general anaesthetic
50
Q

what markers are often raised in bone disease

A

calcium and alkaline phophatase

51
Q

what is spinal claudication

A

when narrowing of spinal canal causes symptoms like vascular claudication but not as severe and often helped by bending forward

52
Q

when should you do an MRI for back pain

A

only if red flags or considering surgery

53
Q

what is seen on x ray of osteoarthritis

A 
loss
loss of joint space
osteophytes
sclerosis
subarticular cysts
54
Q

what are the yellow flags for chronic back pain

A 
low mood 
high levels of pain/ disability 
belief that activity is harmful 
low education level 
obesity 
problem with claim/compensation (secondary gain)
job dissatisfaction
light duties not available at work 
lot of lifting at work

MSK (71 decks)

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