Back Pain Flashcards
Acute low back pain
Less than 6 weeks
Subacute low back pain
Between 6-12 weeks
Chronic low back pain
More than 12 weeks
Prognosis of acute low back pain
70% of patients feel better in 1 week; 90% feel better in 1 month; only about 10% go on to chronic back pain
Causes of mechanical low back pain
Somatic dysfunction
Causes of non-mechanical low back pain
Neoplasia, infection, inflammatory arthritis, viscerosomatic
Red flags of potentially serious spinal pathology
Possible fracture (trauma, pain axial, nonradiating, and severe and disabling)
Possible infection or tumor (cancer, spinal infection - pain that worsens when supine)
Possible cauda equina syndrome (surgical emergency)
Cancer risk factors
Hx, unexplained weight loss, age <20 or >50, failure to improve after 4-6 weeks of therapy
Risk factors for possible spinal infection
Fever and/or chills
IV drug use
Immunosuppression
In the absence of red flags, imaging studies and further testing are not usually helpful during the first…..of low back symptoms
4 weeks (waiting allows 90% of patients to recover)
Common H&P findings of pt with LBP
Trauma, continuous muscle stress (i.e. postural strain), poor lifting mechanics, pain localized to lumbar or lumbosacral area (no radiation to legs, but may involve butt), pain increased with activity, any motion contracting injured muscle reproduces back pain; palpating muscle spasms
Sprain
Ligamentous injury caused by sudden violent contraction, sudden torsion, severe direct blows, or a forceful straightening from a crouched position
Strain
Tears (partial or complete) of muscle-tendon unit
Lumbar sprains/strains
Typical symptoms: pain and muscle spasm localized over posterior lumbar spinal muscle, worsens with movement
Lumbosacral radiculopathy
Cause: nerve root impingement and/or inflammation that has progressed enough to cause neurologic symptoms in the areas supplied by affected nerve roots
Iliolumbar ligament syndrome
Pain in multifidus triangle, pain radiates around iliac crest and possibly into groin on ipsilateral side; mimic inguinal hernia
Degenerative disc disease
Cause: natural aging, poor nutrition, smoking, atherosclerosis, job-related activities, and genetics
Gradual onset of stiffness with or without pain
Discogenic pain without nerve root involvement typically is…
vague, diffuse, and distributed axially
Risk factors for LBP
Preexisting structural deformities (scoliosis, spondylolysis, spinal fusions)
Causes of nerve root impingement in lumbosacral radiculopathy
Herniated disc, spinal stenosis, tumor, hematoma
Piriformis syndrome
Due to pressure on sciatic nerve causing pressure, usually causes impairment or loss of sensory conduction (usually no motor neurological deficitis); symptoms due to combination of nerve entrapment and inflammatory response
Counterstrain tender points (lower pole L5, piriformis, midpole sacroiliac)
Treatments for acute LBP
Pain meds/analgesics, muscle relaxants, exercise, PT, heat, spinal manipulative therapy, surgery
Psoas syndrome
Contraction of psoas major muscle on one side; pt presents with LBP, new, sudden onset scoliosis, inability to stand straight; pelvic shift to opposite side of psoas spasm; piriformis muscle spasm on opposite side (can cause sciatic pain not past the knee)
L4 herniated disc
Motor: tibialis anterior
Reflex: patellar tendon
Sensation: medial foot
L5 herniated disc
Motor: extensor digitorum longus
Reflex: none
Sensation: top of foot
S1 herniated disc
Motor: peroneus longus
Reflex: achilles tendon
Sensation: lateral foot
Spinal stenosis
Spinal canal narrowing with possible neural compression; severe lower extremity pain weakness, numbness in legs while walking; pain worse with extension, better with flexion; physical exam can be normal (straight leg negative, DTRs diminished or not, muscle strength maintained); diagnosed via MRI or CT
Pseudo-sciatica
Normal neurologic exam (about muscles not nerves)
