Back Pain Flashcards
Red flags of back pain
- age <20, >50
- multiple medical problems
- non-msk pain ( aka kidney stones - no comfort w/ position, MOVE patient around!)
- other non MSK complaints (fevers, n/v/d)
- golden rule: back pain + new neurologic symptoms = MRI!
Back pain + new neuro symptoms =
MRI
What are some common neurological symptoms you can see with back pain?
- urinary retention ( get PVR)
- incontinence
- saddle anesthesia
Two groups of non-specific back pain
- hurts w/ pain down leg
2. hurts w/out pain down leg
What do we do in the ED for non-specific, non-radicular back pain w/ out red flags?
Not much in the ED!
- tx with NSAIDS and activity as tolerated
- can use muscle relaxers
- symptoms will likely improve in a couple of weeks (2-6 weeks)
- educate patient on this time course
- warn them about red flag symptoms ( fevers, radicular symptoms)
What do we do in the ED for patient w/ radicular pain w/out red flags?
NOT MUCH!
- many studies have been done and have shown that nothing is helpful
- if you feel inclined, you can gives NSAIDS, prednisone, gabapentin and refer to a pain clinic
- don’t get MRI or any other imaging on all these patients because you might find something you don’t want to find
- sciatica will improve w/out intervention, usually w/in 3 months
Tumor to Bone cancers (7 )- which one is present in young people?
Kidney Ovarian Testicular: YOUNG PEOPLE! Lung Prostate Thyroid Breast
What to order to identify metastatic disease?
- plain films: look for lytic, bastic lesions, pathologic fracture, or just note if its normal!
Cauda Equina
- saddle anesthesia
- stool incontinence/ decreased rectal tone
- urinary retention ( > 100 PVR) or incontinence
- bilateral leg pain ( soft sign)
- GET MRI!
What predicts outcomes in cauda equina?
condition they are in when they get diagnosed= condition they will stay in.
- don’t overlook the suspicious patient w/out HARD signs
imaging and tx for cauda equina?
- MRI: if you dont have MRI you can do CT myelogram
- give steroids in ED
- surgery is definitive treatment
Spinal osteomyelitis/ discitis symptoms
- back pain
- fever
- will have risk profile: IVDU, immunosuppressed, people w/ medical hardware ( pic lines, catheters, ect)
Bacteria in osteomylelitis
- staph
- strep
- TB ( most common world wide)
Dx of osteomyelitis
- MRI is gold standard
- CT if you can’t get an MRI
- Labs: white count, CRP, sed rate ( even though they aren’t great)
- if you miss it causes cord inflammation and infarction, so be thorough and have low index of suspicion!
tx of osteomyelitis
- long term abx
2. drain if abscess
