Back Pain and Fitness to Practice Flashcards
Can the Low Back Exam come up in OSCEs?
Dunno
What are the 5 red flag symptoms for Cauda Equina Syndrome?
- Severe/Progressive bilateral neurological deficit of the legs e.g. major motor weakness with knee extension/ankle eversion/foot dorsiflexion
- Recent-onset urinary retention / incontinence
- Recent-onset faecal incontinence
- Perianal / Perineal sensory loss
- Unexpected laxity of the anal sphincter
What are the 4 red flags for a spinal fracture?
- Sudden-onset of severe central spinal pain relieved by lying down
- History of trauma (including strenuous lifting in people with osteoarthritis)
- Structural deformity of the spine (e.g. a step from one vertebra to the adjacent vertebra)
- Point tenderness over the vertebral body
What are the 7 red flags for cancer or infection (e.g. discitis, vertebral osteomyelitis, or spinal epidural abscess)?
- Onset in <20 years or >50 years
- Pain remaining when supine, aching night pain disturbing sleep, and thoracic pain
- Past hx of cancer
- Fever, chills or unexplained weight loss
- Recent infection (e.g. UTI)
- I.V. drug misuse
- Immunocompromised pts e.g. HIV
What are the 4 red flags for Spondyloarthropathy?
- Early morning stiffness lasting >45 mins
- Night pain
- ‘Gelling’ (stiffening of the joints)
- Easier with movement/worse after rest
What are the 3 red flags for permanent damage to the compressed nerve?
- Significant muscle weakness or wasting
- Loss of tendon reflexes
- Positive Babinski reflex
What are the yellow flags for back pain?
These are social and psych cues that may indicate a patient is at risk of developing CBP
A.B.C.D.E.F.W.
Attitude: toward the current problem
Beliefs: misguided beliefs e.g. cancer, leading to catastrophization
Compensation: is the patient awaiting payment for an accident/injury
Diagnosis: or more importantly Iatrogenesis; misunderstanding of diagnosis e.g. “your spine is crumbling” is much worse to the patient’s mind
Emotions: ongoing depression and anxiety increases the risk of CBP
Family: over-bearing or under-supporting
Work: bad work-life balance
How many days can a patient self-certify a sick note?
7
What does the STarT Back Screening Tool (SBST) tool assess?
Prognosis (low, medium and high risk of poor outcome). Allocates patients to different treatment pathways by helping clinicians identify modifiable risk factors for back pain disability.
What is Spondylolysis?
Typically a Pars Interarticularis stress fracture; shouldn’t cause a lot of pain or disability alone; common in sports people; often mild and causes symptoms in lumbar area; classically seen as a Scottie dog fracture on X-ray
What is Spondylolisthesis?
Vertebral body slippage (not disc) secondary to spondylolysis or degenerative condition; can happen acutely or insidiously; likely to be associated with nerve root symptoms; may be a step deformity noticed on examination. Can cause nerve root compression
What are 4 common causes of mechanical back pain?
- Lumbar muscle sprain/strain
- Bulging, Herniated or Degenerative Intervertebral Disc
- Spinal Stenosis
- Facet joint disease (osteoarthritis)
What are the cancers that tend to metastasise to bone?
Kinds Of Tumours Leaping Promptly To My Bone
Kidney Ovarian Thyroid Lung Prostate Testicular Myeloma Breast
What symptoms make an inflammatory condition resulting in back pain more likely?
Stiffness associated with the pain, and if this lasted longer than 45 minutes
What percentage of the UK population complain of back pain in their lifetime?
What is the estimated annual cost of back pain?
60-80%
£12.3 billion (NHS use, informal care, time off from work)
