Back pain Flashcards
What are red flags for back pain?
Nocturnal Thoracic Worse on lying down Focal neurology Fever, night sweats, weight loss History of malignancy Abdominal mass Morning stiffness Bilateral or alternating leg pain Sphincter disturbance Saddle anaesthesia Immunosuppression
What should you examine in back pain?
Lumbar flexion/extension
Sacroiliitis - palpates over spinous processes and sacroiliac joints for tenderness
Neuro deficits - LL sensation, power, reflexes
DRE for anal tone and sensation
Nerve root pain
Straight leg test (L4, L5, S1)
Femoral stretch (L2-L3) - pain in front of thigh on lifting the hip into extension with patient lying face down and knee flexed
Signs of generalised disease - malignancy
What does straight leg test test?
L4, L5, S1
Positive if raising leg with knee extended causes pain below knee
Suggests irritation to sciatic nerve
Main cause is lumbar disc prolapse
What are causes of back pain in younger people?
Prolapsed disc Trauma Fractures Ankylosing spondylitis Pregnancy
What are causes of back pain in older people
Malignancy
Degenerative spinal disease
Prolapsed disc
What Ix in back pain?
FBC ESR CRP U&E ALP Serum/urine protein electrophoresis PSA
MRI whole spine
What management for back pain?
Urgent neurosurgical referral if any neurological deficit
Continue normal activities
Be active
Regular pain relief
Mechanical back pain:
Rest
Inflammatory back pain:
Keep moving
L2 compression - pain and weakness
Upper thigh
Hip flexion
L3 compression - pain and weakness
Lower thigh
Knee extension
L4 compression - pain and weakness
Across knee to medial malleolus
Foot dorsiflexion
L5 compression - pain and weakness
Lateral shin to dorsum of foot and great toe
Great toe extension
S1 compression - pain and weakness
Posterior calf, lateral foot and little toe
Plantarflexion
What cancers met to spine
Lung breast prostate thyroid kidney
