Back Pain

Question 1

Low back pain

Answer 1

. Pain in lower pain related to lumbar spine problems, discs, ligaments around spine and discs, spinal cord, nerves, muscles of low back, internal organs of pelvis and abdomen, skin over lumbar area

Question 2

Reticular pain

Answer 2

Radiating pain based on spinal nerve roots

Question 3

Trauma/Injury of lower back

Answer 3

. Insulting trauma caused local irritation/injury of a soft or hard tissue resulting in inflammation/pain/somatic dysfunction

Question 4

Low back trauma/injury/somatic dysfunction signs and symptoms

Answer 4

. Pain, dec. ROM, T.A.R.t

Question 5

trauma/injury/somatic dysfunction of lower back etiology

Answer 5

Structural asymmetry, trauma (lifting), overuse, falling, car accident, prolonged sitting/immobility

Question 6

Ankylosing Spondylitis

Answer 6

Inflammatory disorder primarily affects the axial skeleton, peripheral joints, and extra-articular structures may be involved

Question 7

Signs and symptoms of ankylosing spondylitis

Answer 7

. Dull back pain, stiffness upon awakening which improves w/ activity
. Nocturnal exacerbations of pain forced patient to rise
. Bilateral involvement and more persistent pain w/ advanced disease

Question 8

Ankylosing Spondylitis etiology

Answer 8

Unknown
Correlation w/ histocompatibility antigen HLA-B27 (90%) but it independence of disease severity
. NO ROUTE OF TRANSMISSION

Question 9

Cancer resulting in low back pain signs and symptoms an etiology

Answer 9

. Fever, back pain, sciatic pain, weight loss, stiffness upon awakening,
. Determined by location, may affect motor and/or sensory bowel and/or bladder symptoms
. Etiology: multifactorial

Question 10

Fracture causing back pain signs and symptoms, etiology

Answer 10

. Disruption of bone from trauma, osteoporosis, malnutrition, sedentary lifestyle
. Back pain, sciatic pain
. Determined by location, may affect motor/sensory, bowel, and/or bladder
. Etiology: numerous

Question 11

Osteomyelitis

Answer 11

Infection of bone

Question 12

Osteomyelitis signs and symptom

Answer 12

. Fever, back pain w/ movement and direct percussion, inc. pain w/ movement usually present

Question 13

Osteomyelitis etiology

Answer 13

. Pyogenic bacteria and mycobacteria by hematogenous route
. Direct introduction by a contiguous focus of infection, or penetrating wound
. Diabetes, hemodialysis, and IV drug use carry inc. risk of spinal infection

Question 14

Emergent issues w/ low back pain

Answer 14

. Requires rapid treatment
. Neoplasia: multiple myeloma, metastatic carcinoma, lymphoma, leukemia
. infection: osteomyelitis, septic diskitis, paraspinal and epidural abscess

Question 15

Serious but non-emergent low back pain issues

Answer 15

. Osteoporotic compression fractures

. inflammatory arthritis: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and IBD

Question 16

Visceral diseases refer to low back pain requiring rapid diagnosis and treatment

Answer 16

. Retroperitoneal: aortic aneurysm, adenopathy or mass
. Pelvic: prostatitis, endometriosis, pelvic inflammatory disease
. Renal: nephrolithiasis, pyelonephritis, perinephric abcess
. GI: pancreatitis, cholecystitis, penetrating ulcer

Question 17

Red flags associated w/ low back pain

Answer 17

. Urinary retention 
. Saddle anesthesia
. Bilateral leg weakness
. Bilateral sciatica
. Bowel/bladder incontinence

Question 18

Pivotal points that suggest infection is cause of low back pain

Answer 18

. Fever
. Recent skin infection
. UTI
. Immunosuppression
. Diabetes
. Injection drug use

Question 19

Pivotal points to suggest lumbar radiculopathy

Answer 19

. Sciatica

. Abnormal neurological exam

Question 20

Diagnostic approach for low back pain

Answer 20

1. Question cauda equina
2. Infection red flags
3. Malignancy risk factors red flags
4. Compression fracture red flags
5. Spinal stenosis, sciatica w/ neurological exam
6. GI/GU symptoms such as abdominal bruit or endometriosis
7. Consider mechanical, nonspecific

Question 21

Mechanical low back pain

Answer 21

. Non radiating w/ stiffness precipitated by heavy lifting
. Occurs hours/days after event but improves when patient is supine
. No neurological abnormalities
. Absence of red flags is 99% predictive of no serious etiology of lbp

Question 22

Mechanical LBP lifetime prevalence

Answer 22

84%

Question 23

Mechanical LBP risk factors

Answer 23

. Low general health status, psychiatric comorbities, nonorganic signs

Question 24

T/F Patients w/ no red flags should NOT have diagnostic imaging

Answer 24

F

Question 25

Herniated disc

Answer 25

. Moderate-severe pain radiating from back down butt and leg to foot/ankle
. Associated w/ numbness or paresthesias
. Most common at L4/5, L5/S1
. Risk factors: sedentary activities
. No bowel/bladder symptoms w/ unilateral disk herniation

Question 26

Sciatica

Answer 26

. Suggestive of L4/5 or L5/S1 herniated disk

Question 27

How to test straight leg test

Answer 27

. Hold heel w/ 1 hand and slow raise leg keeping knee extended
. Sciatica reproduced 30-60 degrees
. Shooting pain

Question 28

Cauda Equina Syndrome

Answer 28

. Caused by tumor/massive disk herniation
. Urinary retention, urinary incontinence
. Dec. anal sphincter tone
. Saddle anesthesia
. Bilateral leg weakness
. MEDICAL EMERGENCY IMMEDIATE IMAGING AND DECOMPRESSION