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Y2 CONTROL & MOVEMENT > Back Pain > Flashcards

Back Pain Flashcards

1
Q

What are the 3 main functions of the spine?

A
  1. to allow for a range of movement 2. to protect the spinal nerves 3. to act as a shock absorber
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2
Q

What are the 3 main curves in the spine?

A
  1. cervical lordosis
  2. thoracic kyphosis
  3. lumbar lordosis
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3
Q

Why is the cervical spine the most flexible part of the spine?

A

it has relatively thick intervertebral discs in relation to the size of the adjacent vertebrae

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4
Q

What happens to the lumbar lordosis with age?

A

it becomes more flattened

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5
Q

Why do the intervertebral discs become more vulnerable to injury as the day progresses?

A

in the morning they are swollen with water

the annulus and intervertebral ligaments resist bending more strongly

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6
Q

Label the parts of the intervertebral disc

A
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7
Q

What happens to the intervertebral discs with increasing age?

A

the discs lose water and lose strength

they become increasingly thinner

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8
Q

What changes occur in the spine as a result of vertebral disc thinning with increasing age?

A
  1. vertebral end plates and underlying bone structure loses strength
  2. repetitive loading/trauma can result in annular tears in the discs
  3. dryer/weaker discs result in slacker ligaments
  4. the spine becomes less stable
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9
Q

What are osteophytes?

How do they affect the joints in the spine?

A

they are nodules of bone that grow to try and stabilise the spine after damage

this leads to increased load over the facet joints

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10
Q

What can result as a consequence of osteophyte growth in older people?

A

increased load over the facet joints leads to degeneration of the facet joints

this can cause facet joint osteoarthritis

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11
Q

What are the clinical implications of changes in the spine that occur with age?

A
  1. loss of movement
  2. muscle weakness and wasting

there is pain due to the lack of movement of the back

pain prevents patients from exercising, which makes the pain even worse

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12
Q

What are the major two messages for patients with lower back pain?

A

keep flexible and keep strong

patients need to keep moving to increase the strength of the back, as this prevents the pain from getting worse

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13
Q

What are the 4 main factors that influence back pain?

A
  1. genetics
  2. environment - calcium intake, job, sporting activities
  3. body weight - more common in obese patients
  4. muscle strength
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14
Q

Why is mechanical loading good at preventing lower back pain?

A

mechanical loading strengthens the vertebral bodies and increases the water content within the discs

gravity and mechanical force stimulates osteoblast cells to build up the spine

overloading should be avoided

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15
Q

How does back pain affect absences from work in the UK?

A

back pain is the largest cause of absence from work in the UK

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16
Q

What are the 6 main risk factors for lower back pain at work?

A
  1. heavy physical jobs
  2. lifting
  3. driving to work
  4. previous episodes of lower back pain
  5. mental health
  6. posture - laptops, seating, desk set-up
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17
Q

What is important to remember when making a “diagnosis” of lower back pain?

A

low back pain is a SYMPTOM and not a disease

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18
Q

What are the 3 ways in which lower back pain can be classified?

A
  1. simple backache
  2. nerve root involvement
  3. possible serious spinal pathology
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19
Q

When taking a mechanical (simple) back pain history, what is significant about when the first and recurrent episodes occur?

A

the first episode is often a sudden onset while lifting/twisting/turning

recurrent episodes have decreasing inter-episode frequency

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20
Q

Where is the pain in mechanical (simple) back pain?

What is it related to?

A

the pain is variable and related to posture/position

it may radiate to the buttock or leg

it is less painful when lying flat

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21
Q

When is mechanical (simple) back pain better and worse?

A

it is often worse at the end of the day and better with lying down/resting

22
Q

What is the initial treatment for lower back pain?

A

simple analgesics

physiotherapy is recommended if symptoms have been lasting more than a few days

rest for no longer than 1-3 days

23
Q

When is secondary care referral recommended in lower back pain?

A

if the pain has been going on for 6 weeks or more

24
Q

Why are cases of suspected lower back pain rarely X-rayed?

A

100% of elderly patients over 65 have radiological changes including arthritis, disc narrowing and osteophytes

There is no need for an X-ray as degenerative changes in the spine are expected

25
Q

What are the 5 drugs that are given for treatment of lower back pain?

A
  1. paracetamol
  2. NSAIDs
  3. opioids
  4. anti-depressants - amitriptyline, duloxetine
  5. nerve modulators - gabapentin, pregabalin
26
Q

Which drugs should be avoided in elderly patients with lower back pain?

A

opioids are addictive and should be avoided as they can make elderly people confused

NSAIDs should be avoided in patients with hypertension, and elderly people as they are more prone to stomach ulcers

27
Q

Why is amitriptyline (anti-depressant) used in treatment for lower back pain?

A

it relaxes the muscles and helps patients to sleep

(not as an antidepressant)

28
Q

What is the origin of the sciatic nerve?

A

L4 to S3

29
Q

Where does pain occur in sciatica?

A

pain radiates from the back to the leg below the knee

it is NOT sciatica if the pain does not go past the knee

30
Q

What are associated symptoms of sciatica?

A
  1. may be associated with pins and needles in the leg
  2. may be associated with numbness and weakness
31
Q

What is the commonest neurological sign in sciatica?

A

loss of ankle jerk and foot drop

32
Q

What are the red flag symptoms relating to back pain and past medical history?

A
  1. history of carcinoma
  2. UTI or other infection
  3. history of IV drug abuse, HIV positivity or immunosuppression
33
Q

What are the other red flag symptoms associated with lower back pain?

A
  1. age at first onset - young or old
  2. weight loss
  3. constant (24h) pain for more than 1 month
  4. no response to treatment
  5. pain worse at rest - this could be inflammatory back pain
34
Q

What are the 5 cancers that are most likely to have bone metastases?

A
  1. breast
  2. bronchus (Lung)
  3. byroid (thyroid)
  4. bidney (kidney)
  5. brostate (prostate)
35
Q

What are the early signs that may suggest bone metastases?

A

if the back pain wakes you up at night, does not respond to normal pain killers and is getting gradually worse

36
Q

What is the onset of inflammatory back pain like?

When is it better and worse?

A

the onset is insidious

there is nocturnal pain and early morning stiffness

pain gets better with exercise and worse with rest

37
Q

Where does the pain radiate to in inflammatory back pain?

A

if it affects the sacroiliac joints, it can cause back and buttock pain

the pain in the buttocks tends to alternate from one side to the other

38
Q

Which people tend to be affected by axial spondyloarthritis?

What does is affect?

A

if affects young people - men more than women

it causes pain and stiffness in the spine

39
Q

What symptoms are associated with axial spondyloarthritis?

A

it is a large joint arthritis that causes:

  1. enthesitis
  2. iritis
  3. FH of associated diseases - IBD and psoriasis
40
Q

What happens to the ligaments in axial spondyloarthritis?

What usually causes this?

A

the ligaments down the front and back of the spine fuse and become bony

this produces a rigid spine

this can occur from inflammatory back pain that hasn’t been treated

41
Q

What is enthesitis?

A

inflammation where the tendons attach onto the bones

42
Q

What is shown in this X-ray?

A

axial spondyloarthritis

43
Q

What are the main risk factors for osteoporosis?

A
  1. age
  2. being female
  3. smoking
  4. steroids
  5. alcohol
  6. family history
  7. inflammatory conditions
44
Q

What usually occurs, leading to a diagnosis of osteoporosis?

A

simple lifting and bending can lead to fractures

most people don’t know they have osteoporosis until this occurs

45
Q

What causes osteomalacia?

A

a lack of vitamin D

this may be due to diet or lack of sunlight

46
Q

What is involved in Paget’s disease?

A

the femoral head is thickened due to increased bone density

there is increased bone growth in certain areas

47
Q

What are the symptoms of Paget’s disease?

Who is usually affected?

A

prevalence increases with age

it is often asymptomatic but patient’s have raised alkaline phosphatase

48
Q

How is Paget’s disease treated?

What can it cause if it is not treated?

A

it is treated with an IV infusion that works for 3-5 years

it can cause spinal stenosis if untreated

49
Q

What is typically seen in a neoplastic/infection back pain history?

A
  • slow, insidious onset
  • slow deterioration
  • pain is present for 24 hours (all the time)
  • weight loss
  • occasional fever
  • disturbed sleep
50
Q

What causes cauda equina syndrome?

A

the spinal cord finishes at L1 - the cauda equina are the long nerve roots that come down from this level

damage to the bottom of the spine or prolapse can press on the cauda equina

51
Q

What are the symptoms of cauda equina syndrome?

A

1, loss of anal sphincter tone or faecal incontinence

  1. saddle anaesthesia (numbness between the legs)
  2. difficulty with micturition (urination)
  3. low back and/or leg pain

Y2 CONTROL & MOVEMENT (69 decks)

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