Back pain

Question 1

Important causes of back pain

Answer 1

• Degenerative arthritis (spondylosis)
• Disc herniation
• Spinal stenosis
• Vertebral compression Fx
• Traumatic Fx
• Sacroileitis
• Spinal mets
• Spinal epidural abscess
• Cauda equina syndrome

Question 2

Potential diagnostic studies in back pain

Answer 2

• Labs: ESR, CBC, serum alk phos
• Plain xray
• CT
• MRI
• Myelogram
• EMG and nerve conduction studies
• Radionucleotide bone scan
• Bone densitometry

Question 3

Important Hx in back pain

Answer 3

• Disturbs sleep?
• Cancer Hx
• Weight loss
• Fever
• Recent infection
• IV drug use
• Steroid use
• Trauma
• Rapidly progressive focal numbness and/or weakness
• Bowel/bladder dysfunction
• Saddle anesthesia
• Symptoms of systemic rheumatologic conditions
• Anatomic abnormalities (kyphosis, scoliosis)
• Hx recurrent UTIs
• Renal stones
• Smoking
• DM

Question 4

Important PE in back pain

Answer 4

• Spine exam
• Neuro exam of lower extremities
• Straight leg raise test
• Test for saddle anesthesia
• Assessment of rectal tone
• Hip exam (can refer pain to back)

Question 5

Pt education in back pain

Answer 5

-Typical course of back pain
-Methods to prevent development of chronic back pain
-Proper use of analgesics, NSAIDs, muscle relaxants, local heat/ice
-Back hygiene measures, exercises, proper lifting and standing ergonomics
-Lifestyle mods including weight loss
-Role of chiropractic, acupuncture, and massage
-

Question 6

45 F presents with low back pain that radiates to lateral aspect of L foot, straight leg raise positive, unable to tip toe

Answer 6

DDx

• Disc herniation
• Lumbar muscle strain
• Tumor in vertebral canal

Workup

• XR- lumbar spine
• MRI- lumbar spine

Question 7

45 F low back pain started after cleaning house, pain does not radiate, no sensory deficit or weakness in legs, paraspinal muscle tenderness and spasm noted

Answer 7

DDx

• Lumbar muscle strain
• Disk herniation
• AAA
• Vertebral compression fracture

Workup
-XR-lumbar spine

Question 8

45 M pain in lower back and legs during prolonged standing and walking, pain relieved by sitting and leaning forward (eg pushing grocery cart)

Answer 8

DDx

• Lumbar spine stenosis
• Lumbar muscle strain
• Tumor in vertebral canal
• PVD

Workup

• XR-lumbar spine
• MRI-lumbar spine (preferred)
• CT-lumbar spine
• Ankle-brachial index

Question 9

17 M low back pain radiates to L leg and began after fall on knee during gym class, loss of sensation in left foot, pain and sensory loss do not match any known distribution, insists on requesting week off from school due to injury

Answer 9

DDx

• Malingering
• Lumbar muscle strain
• Disk herniation
• Knee or leg Fx
• Ankylosing spondylitis

Workup

• XR-lumbar spine and knee
• MRI- lumbar spine