Back Pain and Radiculopathy

Question 1

List causes of back pain.

Answer 1

• Infection
• Trauma
• Tumour
• Referred pain
• Inflammatory
• Degenerative

Question 2

Low back pain is the __ nd commonest reason to seek medical help

Answer 2

2nd commonest

Question 3

LOW BACK PAIN IS A SYMPTOM NOT A DIAGNOSIS

Answer 3

T

Question 4

What is the prevalence of lower back pain?

Answer 4

60-90%

Question 5

If a condition is ‘subacute’ how long does it last for?

Answer 5

> 6 weeks

Question 6

If a condition is ‘chronic,’ how long does it last for?

Answer 6

> 3 months

Question 7

What sources/types of lower back pain are associated with trauma?

Answer 7

• Musculoligamentous.
• Lumbosacral.
• Osteoporosis (minimal trauma).
• Traumatic spondylolisthesis.
• Post-op.

Question 8

Suggest degenerative causes of lower back pain.

Answer 8

• Disc disease.
• Spondylolisthesis.
• Spinal stenosis.
• Facet joint arthrosis.
• Scoliosis + structural.

Question 9

Give 4 examples of types of infection which may cause lower back pain.

Answer 9

• Discitis.
• Vertebral osteomyelitis.
• Epidural abscess.
• Paraspinal abscess.

Question 10

Give 4 types (in terms of location) of tumours, and specific examples of each, which may cause lower back pain.

Answer 10

• Bony tumours – primary (myeloma) or metastatic (lung, breast).
• Extradural tumours – lymphoma.
• Intradural extramedullary – meningioma, neurofibroma.
• Intradural intramedullary – ependymoma, astrocytoma etc.

Question 11

Suggest inflammatory causes of lower back pain.

Answer 11

• Sacroiliitis.
• Ankylosing spondylitis.
• Any rheumatological condition affecting the spine.
• Arachnoiditis (post-meningitis, post-epidural).

Question 12

Inflammatory back pain is worse in the morning and gets better throughout the day

Answer 12

T

Question 13

What problems may cause referred pain to the lower back?

Answer 13

• Aortic dissection.
• Retroperitoneal disease – pancreas.
• Perispinal disease ie. tumours and abscesses.
• Ovarian/gynaecological problems.

Question 14

Suggest non-organic causes of back pain.

Answer 14

• Psychiatric.
• Malingering (financial/emotional etc.).
• Substance abuse.

Question 15

What other symptoms should you always ask about in a back pain history?

Answer 15

• Weight loss.
• Fever/temperature/sweats.
• Neck/arms/legs.
• Bladder/bowel.
• Cold extremities/non-healing ulcers.

Question 16

What cancer gives you ‘night sweats’?

Answer 16

Lymphoma

Question 17

List the red flags of back pain.

Answer 17

• Acute, rapidly progressive worsening
• Constitutional symptoms - weight loss, fever, headache
• History of malignancy /family history
• Bladder / bowel - cauda equina
• Bilateral pain / weakness
• Pain on lying flat
• First time presentation

Question 18

What is back pain when lying flat a red flag for?

Answer 18

A tumour – especially pancreatic cancer.

Question 19

Outline the key clinical signs and symptoms in ‘sciatica’ or radicular lumbar problems

Answer 19

• Leg pain > > Back pain (usually 1 leg is worse)
• Pain is sharp and shooting.
• RADICULAR.
• Worse on STRETCH / STANDING. - can’t to SLR
• Better on lying with knee bent.
• Painful retention.
• Analgesic-related constipation.

Question 20

What do lumbar spine problems present with?

Answer 20

LEG PAIN&raquo_space;» back pain

Question 21

Outline the key clinical signs and symptoms in spinal stenosis.

Answer 21

• Back pain > > Leg pain.
• Brought about by WALKING.
• Claudication distance.
• Chronic bladder/bowel.
• Gradual bilateral leg weakness.
• +/- radicular pain.

Question 22

What are the key clinical signs/symptoms of cauda equina.

Answer 22

• Back +/or leg pain.
• Bilateral sciatica.
• Bilateral leg weakness.
• Acute bladder/bowel.
• Painless bladder/bowel (VERY WORRYING).
• Perineal numbness.

Question 23

In terms of imaging, what 3 techniques may be used?

Answer 23

• X-ray.
• CT.
• MR.

Question 24

What is the best method for looking at suspected sciatica?

Answer 24

MRI - think about SSC

Question 25

What can be given to treat the nerve pain?

Answer 25

Amitriptyline / Gabapentin

Question 26

Paracetamol shows very little effect

Answer 26

T

Question 27

What is good for treating nerve pain?

Answer 27

Opiates and derivatives - but need to monitor use; consider rotation

Question 28

What advice should be given with regard to proper sitting?

Answer 28

• Hips should be flexed.
• Legs should not be extended.
• Back should not be overly arched.
• Sit for a MAXIMUM OF 30MINS.

Question 29

What advice should be given with regard to proper lifting?

Answer 29

• Back kept erect.
• Knees bent.
• Weight close to body.

Question 30

Outline the management of lower back pain.

Answer 30

• Pain relief.
• Proper sitting and lifting.
• Physio and exercises !!!!!
• Injections.

If none of this works - laminectomy

Question 31

What should you make sure the pt has before starting physiotherapy?

Answer 31

Adequate pain relief

Question 32

What are the aims of physiotherapy?

Answer 32

• Maintain flexibility.
• Maintain free nerve roots.
• Maintain muscle tone.
• Maintain/restore core paraspinal muscle.

Question 33

What are the different techniques for physiotherapy?

Answer 33

• SIT UPS & CRUNCHES (WORK OBLIQUES AS WELL)
• PELVIC TILTS - (FLATTENING OF BACK AGAINST FLOOR)
• HIP LIFTS - (FROM LYING ON BACK POSITION)
• BACK EXTENTIONS - TO 90 DEGREES
• PSOAS & HAMSTRING STRETCH - (KNEES TO CHEST)

Question 34

What is the function of the injections?

Answer 34

Long acting anaesthesia

Question 35

What are the 2 options of analgesia?

Answer 35

• Facet joint injections

* Peri root injections

Question 36

What are decompression surgeries useful for?

Answer 36

• Focal nerve root compression ie. radicular
  compression by a prolapsed disc.
• Multilevel thecal sac compression.