Back Pain Flashcards
Low back pain
. 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
Reticular pain
Radiating pain based on spinal nerve roots
Trauma/Injury of lower back
. Insulting trauma caused local irritation/injury of a soft or hard tissue resulting in inflammation/pain/somatic dysfunction
Low back trauma/injury/somatic dysfunction signs and symptoms
. Pain, dec. ROM, T.A.R.t
trauma/injury/somatic dysfunction of lower back etiology
Structural asymmetry, trauma (lifting), overuse, falling, car accident, prolonged sitting/immobility
Ankylosing Spondylitis
Inflammatory disorder primarily affects the axial skeleton, peripheral joints, and extra-articular structures may be involved
Signs and symptoms of ankylosing spondylitis
. 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
Ankylosing Spondylitis etiology
Unknown
Correlation w/ histocompatibility antigen HLA-B27 (90%) but it independence of disease severity
. NO ROUTE OF TRANSMISSION
Cancer resulting in low back pain signs and symptoms an etiology
. 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
Fracture causing back pain signs and symptoms, etiology
. 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
Osteomyelitis
Infection of bone
Osteomyelitis signs and symptom
. Fever, back pain w/ movement and direct percussion, inc. pain w/ movement usually present
Osteomyelitis etiology
. 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
Emergent issues w/ low back pain
. Requires rapid treatment
. Neoplasia: multiple myeloma, metastatic carcinoma, lymphoma, leukemia
. infection: osteomyelitis, septic diskitis, paraspinal and epidural abscess
Serious but non-emergent low back pain issues
. Osteoporotic compression fractures
. inflammatory arthritis: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and IBD
Visceral diseases refer to low back pain requiring rapid diagnosis and treatment
. Retroperitoneal: aortic aneurysm, adenopathy or mass
. Pelvic: prostatitis, endometriosis, pelvic inflammatory disease
. Renal: nephrolithiasis, pyelonephritis, perinephric abcess
. GI: pancreatitis, cholecystitis, penetrating ulcer
Red flags associated w/ low back pain
. Urinary retention . Saddle anesthesia . Bilateral leg weakness . Bilateral sciatica . Bowel/bladder incontinence
Pivotal points that suggest infection is cause of low back pain
. Fever . Recent skin infection . UTI . Immunosuppression . Diabetes . Injection drug use
Pivotal points to suggest lumbar radiculopathy
. Sciatica
. Abnormal neurological exam
Diagnostic approach for low back pain
- Question cauda equina
- Infection red flags
- Malignancy risk factors red flags
- Compression fracture red flags
- Spinal stenosis, sciatica w/ neurological exam
- GI/GU symptoms such as abdominal bruit or endometriosis
- Consider mechanical, nonspecific
Mechanical low back pain
. 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
Mechanical LBP lifetime prevalence
84%
Mechanical LBP risk factors
. Low general health status, psychiatric comorbities, nonorganic signs
T/F Patients w/ no red flags should NOT have diagnostic imaging
F
Herniated disc
. 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
Sciatica
. Suggestive of L4/5 or L5/S1 herniated disk
How to test straight leg test
. Hold heel w/ 1 hand and slow raise leg keeping knee extended
. Sciatica reproduced 30-60 degrees
. Shooting pain
Cauda Equina Syndrome
. 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
