Back Pain Flashcards
What are some potential causes of back pain
Viscerogenic - due to organs Spondylogenic – joints and muscles of the spine Discogenic – spinal discs Neurogenic – nerve roots Pyschogenic
Describe referred back pain
Tends to be dull
Affects buttock and thigh
Rarely below knee
Ill defined sensory symptoms
Describe nerve root back pain
Distribution will be dermatomal
Sharp, shooting pain
Invariably below the knee to foot/ankle
Anatomical sensory/motor symptoms
How can back problems affect the bowel/urinary tract
Problems with the nerves in the back, particularly the cauda equina
Leads to incontinence and a loss of control/awareness
May get perineal or saddle anaesthesia
List some possible spinal pathologies
Fracture - common in osteoporosis
Tumours - usually metastases but can be myeloma
Infection
Inflammatory - e.g. ankylosing spondylitis
Which cancers commonly metastasise to the bones
Breast Lungs Prostate Thyroid Kidneys
Which other features suggest the back pain is caused by cancer
Weight loss Anaemia Anorexia Night pain Constant pain Other symptoms linked to primary location
Which other features suggest the back pain is caused by infection
Fever
Temperature
History of foreign travel
What are some nerve root problems that can cause back pain
Disc prolapse
Large vertebral canal - pain from stretched annulus/posterior long ligament
Small vertebral canal - root compression
Describe the meaning of disc prolapse
Disc protrudes out but is contained by ligament
Describe the meaning of disc extrusion
Disc pushes out past the ligament
Describe the meaning of disc sequestration
Nucleus pulposis squirts out of the disc itself
How do you diagnose mechanical back pain
Diagnosis of exclusion
Must check there are no nerve root problems and no underlying pathological processes
Which joints are common causes of mechanical back pain
Facet joints - common to get arthritic changes and malalignment
Sacroiliac - common source of referred back pain
What is the most common type of back pain
Mechanical
What is the most common cause of loss of lumbar lordosis
Spasm
How do you test for nerve irritation/weakness in L1/2
Hip flexion
How do you test for nerve irritation/weakness in L3/4
Knee extension
How do you test for nerve irritation/weakness in L5
foot dorsiflexion
How do you test for nerve irritation/weakness in S1/2
Ankle plantar flexion
Which test is used to check for sciatica
Straight leg raise
If sciatica is cause this will trigger the pain
What is sciatica
Buttock and/or leg pain with a specific dermatomal distribution accompanied by neurological disturbance
Prolapsed discs are always the cause of back pain - true or false
False
May be completely asymptomatic
This is why scans aren’t always diagnostic as disc problems can be picked up incidentally
Describe the common presentation of a disc prolapse
Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dominant
How do you treat disc prolapse
Treat pain first
70% settle in 3 months whilst 90% will have settled in 18-24 months
Surgery only used in severe cases or if cauda equina affected - very high risk op
What are some psychosocial yellow flags that may be seen in back pain
Belief that back pain is harmful or potentially seriously disabling Fear/ avoidance behaviour Low mood / withdrawal Passive rather than active Job dissatisfaction Problem with claim/compensation Obesity Low education
Psychological factors and stress can lead to back pain - true or false
True
What are the most common presentations of back problems
Pain Referred pain - down legs Stiffness Loss of sleep Loss of function - e.g. struggling to walk, lift or carry things
How would compression of the femoral nerve present
Pain will refer down the front of the leg
Less common than sciatica
What urinary tract pathologies can cause back pain
Kidney stones
Renal colic
What GI tract pathologies can cause back pain
Pancreatitis - usually get at front too
Gall bladder?
What respiratory tract pathologies can cause back pain
Rarely pneumonia in lower lobes can lead to back pain
What systemic illnesses can cause back pain
MANY
Viral infection such as flu commonly cause aches anf pains
What investigations are done for back pain
Usually nothing
Blood tests if suspect inflammatory cause
Calcium & Alk Phos - can indicate bone damage
MRI -gold standard as shows soft tissue which is the most common cause of back pain
What are some red flags of back pain
Age under 20 or over 55 Thoracic pain Previous cancer Immunocompromised Feeling unwell or presence of other illness Bladder or bowel dysfunction Weight loss and fever Widespread and progressive neurological symptoms Disturbed gait, saddle anaesthesia Structural deformity
List some common managements of back pain
Explain and reassure Encourage them to keep moving Analgesia NSAID -short term Muscle relaxants - e.g. diazepam Physio Osteopathy or chiropractic Referral if very severe
What are the normal curves of the spine
cervical lordosis
thoracic kyphosis
lumbar lordosis
