Back Pain Flashcards
back pain red flags
age < 20 or > 55 years neurological disturbance sphincter disturbance bilateral / alternating leg pain current / recent infection fever, weight loss, night sweats history of malignancy morning stiffness nocturnal pain acute onset in elderly constant / progressive pain
what is mechanical back pain
relapsing + remitting back pain
worse with movement, relieved by rest
no red flag symptoms present
patients aged 20-60
causes of mechanical back pain
obesity poor lifting technique poor posture lack of exercise facet joint OA spondylosis
what is spondylosis
intervertebral disks lose water content with age
- less cushioning
- increased pressure on facet joints – secondary OA
Tx mechanical back pain
physiotherapy + analgesia
what is an acute disc tear
tear in annulus fibrosis of intervertebral disk
presentation of acute disc tear
acute onset pain, typically after lifting heavy object
pain worse on coughing - increased disc pressure
- 2-3 months to heal
complication of disc tear
herniation of nucleus pulposis through tear – impingement of exiting nerve root resulting in dermatomal pain + altered sensation and reduced myotomal power
roots of sciatic nerve
L4, L5, S1
describe radicular (nerve compression) pain in sciatica
burning pain radiating down back of thigh to knee + buttock
positive femoral stretch test indicated what
sciatica
a prolapse at L3/4 affects what root ?
L4 - lower of the 2 vertebrae is affected
symptoms of L4 root entrapment
pain down to medial ankle
loss of power quadriceps
reduced knee jerk
symptoms of L5 root entrapment
sensory loss dorsum of foot
weak dorsiflexion
reflexes intact
symptoms of S1 root entrapment
pain to sole of foot
reduced power plantar-flexion
reduced ankle jerks
treatment of sciatica
analgesia + physiotherapy
- neuropathic analgesia if severe e.g. gabapentin, amytriptylline
how can radiculopathy due to osteophyte impingement be managed
surgical decompression with trimming of impinging osteophytes
what is spinal stenosis
narrowing of spinal canal due to combination spondylosis + bulging discs + osteophytes
presentation of spinal stenosis
pain on walking, patients > 60
differences between claudication in spinal stenosis and claudication in PVD
in spinal stenosis:
- claudication distance is inconsistent
- pain is burning rather than cramping
- pain is less walking uphill (spine flexion creates more space for cauda equina)
- pedal pulses are preserved
bilateral leg pain, saddle numbness, urinary retention, faecal incontinence
suggestive of?
cauda equina until proven otherwise
urgent investigations of cauda equina
PR exam
MRI to determine level of prolapse
treatment of cauda equina
urgent surgical decompression
slow onset neck pain + stiffness which may radiate to shoulders + occiput. no red flag symptoms
most likely to be
cervical sponylosis
what conditions can cause atraumatic cervical spine instability
Rheumatoid arthritis
Down’s syndrome
what are children with downs syndrome at risk of developing?
atlanto-axial (C1+C2) instability
complication of cervical spine instability
spinal cord compression
what screening should children with downs syndrome get
flexion-extension Xrays
- will show instability
how does cervical spine instability occur in RA
Destruction of synovial joint
Rupture of transverse ligament
treatment of
- mild
- severe
cervical spine instability
mild - collar to prevent flexion
severe- cervical fusion
