Back pain Flashcards
What are the red flag symptoms of back pain?
Progressively worsening pain which is not relieved by rest
Age <20yo or >50yo
Urinary/faecal incontinence, leg weakness and saddle anaesthesia
History of cancer, weight loss and fever
Severe trauma or minor trauma in the presence of osteoporosis
What are the yellow flag symptoms of back pain?
Negative attitude that their back pain is severely disabling
Belief that activity is harmful to recovery
Belief that passive treatment will be beneficial
Depression and social withdrawal
Financial difficulties
What is the difference between red and yellow flag symptoms?
Red flag symptoms may indicate serious pathology whereas yellow flag symptoms are prognostic of long term disability
List some non-spinal causes of back pain
Endometriosis AAA Renal calculi Fibromyalgia Pancreatitis
Describe the typical history of mechanical back pain
Usually a localised pain that worsens with movement and changes in posture
History of trauma or heavy lifting
History of previous similar episodes
No features of systemic illness or neurological symptoms
Describe the typical history of a prolapsed intervertebral disc
Sudden severe lower back pain bought on by heavy lifting
Nerve root involvement - shooting pain down leg that extends below the knee with dermatomal paraesthesia
Which nerve is commonly involved in a prolapsed intervertebral disc?
Sciatic nerve
Describe the typical history of someone presenting with back pain caused by malignancy
Systemically unwell with weight loss and symptoms of primary malignancy
Usually gradual onset, with constant pain not relieved by rest
History of malignancy with tendency to metastasise to bone
Which cancers commonly metastasise to bone?
Multiple myeloma Breast Prostate Lymphoma Lung Kidney Thyroid
Describe the typical history of someone presenting with cauda equina syndrome
Urinary and faecal incontinence
Sensory numbness of buttocks, backs of thighs and weakness in the legs
What are the most common causes of cauda equina syndrome?
Malignancy
Infection
Describe the typical history of an osteoporotic vertebral crush fracture
Sudden localised back pain after minimal trauma
What are the risk factors for osteoporosis
Female, early age of menopause (<40), corticosteroid use, smoking, malabsorption, increasing age
Describe the typical history of someone with a seronegative spondyloarthropathy
Typically a young male of Caucasian origin
Morning stiffness lasting >1hour which improves with exercise
Reduced range of movement of spine, characteristic question mark spin
Name some conditions considered seronegative spondyloarthropathy
Ankylosing spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis
Name the marker associated with seronegative spondyloarthropathy
HLA-B27
Describe the typical presentation with back pain caused by infection
Severe back pain in systemically unwell patient with fever and night sweats
Which infection can cause back pain?
TB in Potts disease
Describe the typical history of spinal stenosis
Associated with degenerative changes, so common in the elderly
Pain bought on by exercise and relieved by rest and stooped forward posture
List some investigations which may be performed for someone with back pain
Back and lower limb neurological examination
Bloods - FBC, LFTs, U&Es, CRP, ESR, HLA-B27
Chest X-ray and QuantiFERON TB Gold if TB suspected
MRI/CT if cord compression or cauda equina suspected
X-ray and DEXA if crush fracture suspected
What is first line management of simple back pain
Advise to stay active and avoid prolonged bed rest, NSAIDs, paracetamol, physiotherapy and consider short course of muscle relaxants
What is the management of cord compression?
Dexamethasone
Surgery
Radiotherapy for malignancy
What is the management of cauda equina?
Urgent surgery
What is the management of ankylosing spondylitis?
NSAIDs
What is the management of osteoporosis?
Bisphosphonates
Vitamin D
Calcium supplements
