Back Pain Flashcards
1
Q
What is the presentation of Mechanical Back Pain?
A
- Typically, worse when moving
- Develop suddenly or gradually
- Results of poor posture or lifting something awkwardly at times
- Minor injury such as Spain or strain
- Associated with stress sometimes
2
Q
How is Mechanical Back Pain managed?
A
- Get better over time few weeks
- Asses risk with StarT Back
- Self-management advice
- Offer analgesia to manage the pain
3
Q
Which analgesia are used to manage mechanical back pain?
A
- NSAIDs to start. If contraindication, then codeine with or without paracetamol
- 30-60mg Codeine with/without paracetamol every 4 hours
- If presenting with back spasms, then short course of benzodiazepine such as diazepam (2mg up to 3 times a day for up to 5 days)
- Follow up if the symptoms persist or worsen after 3-4 weeks
4
Q
What is the presentation of Cauda Equina?
A
- Bilateral sciatica
- Severe or progressive bilateral neurological deficit of the legs such as motor weakness with knee extension, ankle eversion or foot dorsiflexion
- Difficulty initiating micturition or impaired sensation of urinary glow, if untreated this may lead to irreversible. (Overflow Incontinence)
- Loss of sensation of rectal fullness leading to faecal incontinence
- Perianal, perineal or genital sensory loss (saddle anaesthesia)
- Laxicity of the anal sphincter
5
Q
How is cauda equina managed?
A
Refer for imaging and specialist assessment as soon as possible as it is an emergency
6
Q
What is the presentation of a slipped disc?
A
- Lower back pain
- Numbness or tingling in your shoulder, back, arms, hands, legs, or feet
- Neck pain
- Problems bending or straightening your back
- Muscle weakness
- Pain in the buttocks, hips or legs if the disc is pressing on the sciatic nerve
7
Q
How is a slipped disc managed?
A
- Keep active
- Take analgesics such as ibuprofen and paracetamol. Take regularly. Codeine can be taken if NSAIDS contraindicated. Codeine with/without paracetamol. 30-60 mg every 4 hours
- Physiotherapist
- GP can treat with steroid injection, muscle relaxant or stronger painkiller
8
Q
How does Sciatica present?
A
- Inability to straight leg raise
- Painful/Tingling/Numbness/Weakness in the bottom, back of your legs or feet and toes
- May have back pain as well
9
Q
How is Sciatica managed?
A
- Prescription of painkillers (NSAIDs at the lowest dose with gastroprotection, Codeine with/without paracetamol. 30-60 mg every 4 hours)
- Suggest exercises and stretches
- Physiotherapist
- Psychological support
- If spasms consider prescription of diazepam
10
Q
How does ankylosing spondylitis present?
A
- Back pain and stiffness
- Pain and swelling in other parts of the body caused by inflammation of the joints and inflammation where a tendon joins a bone
- Extreme tiredness
11
Q
How is Ankylosing Spondylitis managed?
A
- Exercises carried out individually or in groups to reduce pain and stiffness
- Physiotherapist where physical methods such as massage and manipulation are used to improve comfort and spinal flexibility
- Medication to help relieve pain and reduce inflammation such as pain killers such as NSAIDs, anti TNF medication and biological therapies
12
Q
What are the causes of Spondylolisthesis?
A
- Dysplastic spondylolisthesis - Birth defect in part of the vertebra causes slip forward
- Isthmic spondylolisthesis - Repetitive trauma to the spine
- Degenerative spondylolisthesis - Joints of the vertebrae becoming worn and arthritic
- Sudden injury or trauma to the spine
- Bone abnormality
13
Q
What is the presentation of Spondylolisthesis?
A
- Lower back pain which is usually worse during activity and when standing and is often relieved by lying down
- Pain, numbness or a tingling sensation radiating from your lower back down your legs (occurs if the slipped vertebra presses on a nerve)
- Tight hamstring muscles
- Stiffness or tender in your back
- Excessive curvature of the spine (kyphosis)
14
Q
How is Spondylolisthesis managed?
A
- Imaging required – CT scan
- Short period of rest, avoiding activities such as bending, lifting, contact sports and athletics
- Anti-inflammatory painkillers
- Physiotherapy
- Corticosteroid injections around the compressed nerve and into the spinal canal are recommended
15
Q
What are red flags for infection of the bone/spine?
A
- Fever
- Tuberculosis or recent urinary tract infection
- Diabetes
- History of intravenous drugs use
- HIV infections use of immunosuppressant or immunocompromised
16
Q
What is the presentation for a broken bone in spine?
A
- Sudden onset of severe central spinal pain which is relieved by lying down
- History of major trauma
- Structural deformity of the spine
- Point tenderness over a vertebral body
17
Q
What are some red flag signs for presentation of Cancer of the Spine?
A
- Localized spinal tenderness
- Unexplained weight loss
- Refer to specialist
18
Q
What is the history in a pain with cancer? (red flag)
A
- Over 50
- Gradual onset of symptoms
- Severe unremitting pain that remain when the person is supine, aching night pain that prevent or disturbs sleep, pain aggravated by straining and thoracic pain
- No symptomatic improvement after four to six weeks of conservative low back pain therapy
- Past history of cancer – breast, lung, gastrointestinal, prostate, renal, and thyroid cancers are more likely to metastasise to the spine
19
Q
When are sprains and strains referred from primary care?
A
- Fracture
- Dislocation
- Damage to nerves or circulation
- Tendon Rupture
- Wound penetrating the joint
- Known Bleeding disorder
- Signs of Septic Arthritis
- Large Intramuscular Hematoma
- Complete tear or tear of more than half the muscle belly
20
Q
What can primary care do to manage Sprains and Strains?
A
- Prescribe Paracetamol or topical non-steroidal anti-inflammatory drugs
- Codeine can be used as an add-on to paracetamol if necessary
- Codeine + oral NSAIDs 48 hours after the initial injury if needed
21
Q
How are Sprains and Strains managed?
A
- Protection - protect from further injury (for example by using a support or high-top, lace-up shoes).
- Rest - avoid activity for the first 48-72 hours following injury.
- Ice - apply ice wrapped in a damp towel for 15-20 minutes every 2-3 hours during the day for the first 48-72 hours following the injury. This should not be left on whilst the person is asleep.
- Compression - with a simple elastic bandage or elasticated tubular bandage, which should be snug but not tight, to help control swelling and support the injury. This should be removed before going to sleep.
- Elevation - keep the injured area elevated and supported on a pillow until the swelling is controlled. If the leg is injured, prolonged periods with the leg not elevated should be avoided.
22
Q
How is harm avoided in the first 72 hours after the injury?
A
The DONTs
- Heat - for example hot baths, saunas, and heat packs.
- Alcohol - increases bleeding and swelling and decreases healing.
- Running - or any other form of exercise which may cause further damage.
- Massage - may increase bleeding and swelling.
23
Q
What is the immobilisation required for sprains?
A
- If severe, short period of immobilization can result in quicker recovery
- For less severe sprains, advisable not to immobilize the join. Begin flexibility exercises as soon as they can be tolerated without excessive pain
24
Q
What is the immobilisation required for strains?
A
- Immobilize the injured muscle for the first few days after the injury. Consider the use of crutches in severe injuries.
- Start active mobilization after a few days if the person has pain-free use of the muscle in basic movements and the injured muscle can stretch as much as the healthy contralateral muscle.
25
What are safety netting advise for people with sprains and strains?
* **Advise person to seek further medical advice if in 5-7 days** there is worsening symptoms or lack expected movement
* **Consider reviewing a strain after a few days to asses muscle contractile function,** depending on severity of the injury
* **Consider the need for referral to an orthopaedic specialist** if recovery is slower than expected, there are worsening or ne symptoms, symptoms are out or proportion to degree of trauma.
* **Referral for physiotherapy is not recommended for sprains** but may be considered for strains
26
What are types of Tendinitis?
* Patellar tendonitis – knees
* Tennis Elbow – lateral epicondylitis
* Golfer’s elbow – Medial epicondylitis
* Calcific tendonitis or Supraspinatus
* Tendonitis de Quervain’s disease – affects wrists and thumbs
* Achilles Tendonitis – Heels
* Biceps Tendonitis – Upper arm
27
What are the causes of tendinitis?
* Swollen and painful tendon after injury.
* You can treat mild tendon injuries yourself and should feel better within 2 to 3 weeks
28
What are symptoms of Tendinitis?
* Pain in tendon which gets worse on movement
* Difficulty moving the tendon
* Feeling a grafting or crackling sensation when you move the tendon
* Swelling, sometimes with heat or redness
* Lump along the tendon
29
What is the management of Tendinitis?
* Advise the person to use cold packs, pain relief and rest.
* Refer to physiotherapy
* Can give NSAIDs, Paracetamol
* Long term or severe tendonitis may be offered:
* Steroid injections
* Surgery
* Shockwave therapy
* Platelet rich plasma injections which may help speed up healing
30
What are symptoms of Rheumatoid Arthritis?
Affects small joints in hands and feet symmetrically
* Joint pain
* Swelling, warmth and redness
* Stiffness which can be more severe in the morning
* Inflammation in other parts of the body
* Tiredness and lack of energy
* High temperature
* Sweating
* Poor appetite
* Weight loss
* Dry eyes and chest pain
31
What are causes of Rheumatoid Arthritis?
* Autoimmune condition results in antibodies attacking the tissue surrounding the lining of joints mistakenly.
* This causes the thin layer of cells covering your joints to become sore and inflamed, release chemicals than damage nearby bones, cartilage, tendons and ligaments.
* If the condition isn’t treated, the chemicals gradually cause joints to lose its shape and alignment.
* Eventually the joint can be completely destroyed.
32
What are risk factors for Rheumatoid Arthritis?
* Genes
* Hormones
* Smoking
33
What are investigations for Rheumatoid Arthritis?
* Blood tests
* Erythrocyte sedimentation rate
* C-reactive protein
* Full blood count
* Rheumatoid factor and Anti-CCP antibodies
* Joint imaging such as X-rays and MRI scan
* Assessing physical activity
34
What are symptoms of Osteoarthritis?
* Joint pain and stiffness
* Swelling, tenderness
* Grafting or Crackling sound hen moving the affected joints
* Most commonly affects knees, hips and small joints of the hands
35
What are some risk factors for Osteoarthritis?
* Joint injury
* Other conditions such as rheumatoid arthritis or gout
* Age
* Family history
* Obesity
