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Musculoskeletal > Back Pain and Prolapsed Discs > Flashcards

Back Pain and Prolapsed Discs Flashcards

1
Q

Is back pain multifactorial or single factor based?

A

Back pain is a multifactorial problem

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2
Q

What factors should be included in the assessment of back pain?

A 
History
Examination
Social Factors
Occupational Factors
Litigation
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3
Q

What questions are important in history?

A 
Onset of pain
Previous episodes
Site/Nature of Pain
Radiation of Pain
Neurological Symptoms (Weakness, Paraesthesia, Numbness)
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4
Q

What does paraesthesia mean?

A

Sensation of tingling or pricking (pins and needles)

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5
Q

What are some red flags for back pain?

A

Non mechanical pain
Systemic upset
Major, New Neurological Deficit
Saddle Anaesthesia +/- bowel or bladder upset

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6
Q

What is non mechanical pain?

A

This is pain that does not vary with activity or the time of day
RED FLAG

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7
Q

What is Saddle Anaesthesia?

A

Loss of sensation restricted to the buttocks

Surgical emergency

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8
Q

Describe what you would do in examination?

A

Inspection
Assess range of movement - Shober’s test
Neurological Examination
Nerve Root Irritation

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9
Q

How would you test the myotomes?

A 
L1/l2 = Hip Flexion
L3/l4 = Knee Extenion
L5 = Foot Dorsiflexion
S1/S2 = Ankle Plantarflexion
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10
Q

What reflexes do you test?

A

Knee and Ankle Jerk

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11
Q

How would you test nerve root irritation?

A

Straight leg raise tests the sciatic nerve

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12
Q

Name 3 investigations in back pain?

A

X-Rays
MRI
Diagnostic Facet Joint

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13
Q

Describe X Rays in back pain?

A

Most patients have an abnormality
X -Rays just bring unecessary distress
Not help

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14
Q

Describe MRI in back pain?

A

First line
Shows up detail
Can show up too much detail though

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15
Q

What is Sciatica?

A

Vague buttock or leg pain that is not obviously coming from the knee, hip or ankle

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16
Q

Surgeons definition of Sciatica?

A

Buttock or leg pain that is in a specific dermatomal distribution with neurological disturbance

17
Q

Describe how varied prolapsed disc presentation is?

A

Prolapsed disc can present in a number of ways

Can present as back pain, leg pain or asymptomatic

18
Q

Describe the classic presentation of a prolapsed disc?

A

Episodic back pain
Onset of leg pain which may become dominant
May be neurological changes

19
Q

Is prolapsed disc an emergency?

A

No

But consider possible Cauda Equina

20
Q

Describe the pattern of prolapsed disc pain?

A

The pain and presentation follows specific myotomes and dermatomes.
By following these back, you can pinpoint the slipped disc

21
Q

Treatment of prolapsed disc?

A

70% will settle in 3 months
Most will settle in two years
Surgery for those whose doesn’t settle quickly

22
Q

Describe the risks and benefits of surgery for prolapsed disc?

A

Risky
May cause may damage than healing
Used when patients have had symptoms for a long time and is affecting life
Has no overall affect on long term

23
Q

How do you manage general backache in primary care?

A 
Bed Rest for a short time
Anti-inflammatories
Muscle relaxant for 4-5 days if severe
Mobilise patient as soon as possible
Focus on keeping moving and exercising
24
Q

How is backache that has been referred treated?

A

Education
Physiotherapy
Pain Clinic
SURGERY IS A LAST OPTION

25
Q

Describe surgery for back pain?

A

Only recommended for a tiny number of patients
High risk
Can leave some more damaged than before
Needs counselling about risks

26
Q

What is adjacent segment disease?

A

This is when people have disease in some segments of their back and they undergo fusion
Later, they present with pain in other segments
You can’t fuse the whole back!

27
Q

Describe chronic pain syndromes?

A 
Alteration in the central pain perception (patients perceive pain differently than others)
Many different causes
Causes chronic pain Eg:
Fibromyalgia
Back pain
Chronic Fatigue
IBS
Migraines/Headaches
28
Q

Describe the other co-morbdities with back pain?

A

Headache
Tiredness
Mental Disorders

29
Q

What are the pyschosocial yellow flags for back pain?

A

Belief that back pain is harmful or disabling
Fear/Avoidance Behaviour
Low Mood/Withdrawal
Passive rather than active

Musculoskeletal (23 decks)

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