Back Pain and Radiculopathy Flashcards
List causes of back pain.
- Infection
- Trauma
- Tumour
- Referred pain
- Inflammatory
- Degenerative
Low back pain is the __ nd commonest reason to seek medical help
2nd commonest
LOW BACK PAIN IS A SYMPTOM NOT A DIAGNOSIS
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What is the prevalence of lower back pain?
60-90%
If a condition is ‘subacute’ how long does it last for?
> 6 weeks
If a condition is ‘chronic,’ how long does it last for?
> 3 months
What sources/types of lower back pain are associated with trauma?
- Musculoligamentous.
- Lumbosacral.
- Osteoporosis (minimal trauma).
- Traumatic spondylolisthesis.
- Post-op.
Suggest degenerative causes of lower back pain.
- Disc disease.
- Spondylolisthesis.
- Spinal stenosis.
- Facet joint arthrosis.
- Scoliosis + structural.
Give 4 examples of types of infection which may cause lower back pain.
- Discitis.
- Vertebral osteomyelitis.
- Epidural abscess.
- Paraspinal abscess.
Give 4 types (in terms of location) of tumours, and specific examples of each, which may cause lower back pain.
- Bony tumours – primary (myeloma) or metastatic (lung, breast).
- Extradural tumours – lymphoma.
- Intradural extramedullary – meningioma, neurofibroma.
- Intradural intramedullary – ependymoma, astrocytoma etc.
Suggest inflammatory causes of lower back pain.
- Sacroiliitis.
- Ankylosing spondylitis.
- Any rheumatological condition affecting the spine.
- Arachnoiditis (post-meningitis, post-epidural).
Inflammatory back pain is worse in the morning and gets better throughout the day
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What problems may cause referred pain to the lower back?
- Aortic dissection.
- Retroperitoneal disease – pancreas.
- Perispinal disease ie. tumours and abscesses.
- Ovarian/gynaecological problems.
Suggest non-organic causes of back pain.
- Psychiatric.
- Malingering (financial/emotional etc.).
- Substance abuse.
What other symptoms should you always ask about in a back pain history?
- Weight loss.
- Fever/temperature/sweats.
- Neck/arms/legs.
- Bladder/bowel.
- Cold extremities/non-healing ulcers.
What cancer gives you ‘night sweats’?
Lymphoma
List the red flags of back pain.
- 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
What is back pain when lying flat a red flag for?
A tumour – especially pancreatic cancer.
Outline the key clinical signs and symptoms in ‘sciatica’ or radicular lumbar problems
- 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.
What do lumbar spine problems present with?
LEG PAIN»_space;» back pain
Outline the key clinical signs and symptoms in spinal stenosis.
- Back pain > > Leg pain.
- Brought about by WALKING.
- Claudication distance.
- Chronic bladder/bowel.
- Gradual bilateral leg weakness.
- +/- radicular pain.
What are the key clinical signs/symptoms of cauda equina.
- Back +/or leg pain.
- Bilateral sciatica.
- Bilateral leg weakness.
- Acute bladder/bowel.
- Painless bladder/bowel (VERY WORRYING).
- Perineal numbness.
In terms of imaging, what 3 techniques may be used?
- X-ray.
- CT.
- MR.
What is the best method for looking at suspected sciatica?
MRI - think about SSC
What can be given to treat the nerve pain?
Amitriptyline / Gabapentin
Paracetamol shows very little effect
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What is good for treating nerve pain?
Opiates and derivatives - but need to monitor use; consider rotation
What advice should be given with regard to proper sitting?
- Hips should be flexed.
- Legs should not be extended.
- Back should not be overly arched.
- Sit for a MAXIMUM OF 30MINS.
What advice should be given with regard to proper lifting?
- Back kept erect.
- Knees bent.
- Weight close to body.
Outline the management of lower back pain.
- Pain relief.
- Proper sitting and lifting.
- Physio and exercises !!!!!
- Injections.
If none of this works - laminectomy
What should you make sure the pt has before starting physiotherapy?
Adequate pain relief
What are the aims of physiotherapy?
- Maintain flexibility.
- Maintain free nerve roots.
- Maintain muscle tone.
- Maintain/restore core paraspinal muscle.
What are the different techniques for physiotherapy?
- 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)
What is the function of the injections?
Long acting anaesthesia
What are the 2 options of analgesia?
- Facet joint injections
* Peri root injections
What are decompression surgeries useful for?
- Focal nerve root compression ie. radicular
compression by a prolapsed disc. - Multilevel thecal sac compression.
