Back Pain Flashcards
3 types of back pain
Mechanical
Inflammatory
Infiltrative
Characteristics of inflammatory back pain
Age of onset under 40 Prolonged morning stiffness Worse with rest Better with activity Nocturnal awakening Alternating buttock pain Better with NSAIDs
Historical red flags
Pain at rest or at night Trauma Hx of malignancy Constitutional symptoms (fever, chills, night sweats, weight loss) Incontinence Saddle anesthesia Substance abuse Systemic steroids/immunosuppressed First episode of severe pain age > 50
Physical exam red flags
Decreased ROM (passive) Midline tenderness New or progressive neurologic deficit UMN findings (spasticity) Loss of balance/abnormal gait
Cauda equina syndrome
Red flag syndrome Occurs when the end of the spinal cord is compressed by tumor, disc, or infection Contains nerve roots L4-S4 Diagnosis confirmed by CT or MRI Often requires surgical decompression
Symptoms of cauda equina syndrome
Back pain (acute or chronic) Saddle anesthesia (S3-S5) Bladder and bowel dysfunction Lower leg weakness Lower leg sensory changes
Causes of mechanical back pain
Ligament sprains and muscle strains Discogenic pain Facet arthropathy Spondylolithesis Spinal stenosis SI ligament sprain Congenital disease
Ligament sprains and muscle strains
Can be due to acute injury or chronic overuse
Often symptoms are worse with specific movements that stress the affected ligament or muscle
Usually will improve with rest and progressive strengthening program
Discogenic back pain
Can be related to degenerative disc disease or disc herniation
May be an symptomatic part of aging
Degenerative disc disease
Microfracture of collagen and loss of proteoglycans and fluid leading to a dry, dessicated disc
Will see disc space narrowing on x-ray
More insidious onset of chronic pain
Facet arthropathy
Prone to OA
Most common etiology is aging
Often patients have unilateral neck or low back pain in non-dermatomic pattern
Pain is worse with leaning back or lumbar extension or lateral flexion to the affected side
Spondylolithesis
Occurs when one vertebra is sitting forward on the vertebra below it
Sometimes due to non union, lysis or fracture
Often due to developmental variation of the neural arches
Often back pain is worse with forward flexion
Spinal stenosis
Narrowing of the spinal canal
Can be due to many processes
Hx of spinal neurogenic claudication with walking
Spinal claudication
Comes on with walking, better when sitting
Walking with shopping cart easier (bending forward)
Walking uphill easier (downhill = hyperextension)
Vascular claudication
Comes on with walking, better with stop and stand
Risk factors for peripheral vascular disease or known athero
Abnormal ankle-brachial index
Weak pedal pulses
