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Year 3: GP > Back Pain > Flashcards

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
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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
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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
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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
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5
Q

How is cauda equina managed?

A

Refer for imaging and specialist assessment as soon as possible as it is an emergency

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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
Q

What are safety netting advise for people with sprains and strains?

A
  • 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
Q

What are types of Tendinitis?

A
  • 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
Q

What are the causes of tendinitis?

A
  • Swollen and painful tendon after injury.
    • You can treat mild tendon injuries yourself and should feel better within 2 to 3 weeks
28
Q

What are symptoms of Tendinitis?

A
  • 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
Q

What is the management of Tendinitis?

A
  • 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
Q

What are symptoms of Rheumatoid Arthritis?

A

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
Q

What are causes of Rheumatoid Arthritis?

A
  • 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
Q

What are risk factors for Rheumatoid Arthritis?

A
  • Genes
  • Hormones
  • Smoking
33
Q

What are investigations for Rheumatoid Arthritis?

A
  • 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
Q

What are symptoms of Osteoarthritis?

A
  • 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
Q

What are some risk factors for Osteoarthritis?

A
  • Joint injury
  • Other conditions such as rheumatoid arthritis or gout
  • Age
  • Family history
  • Obesity

Year 3: GP (5 decks)

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