Back Pain and Radiculopathy Flashcards

1
Q

List causes of back pain.

A
  • Infection
  • Trauma
  • Tumour
  • Referred pain
  • Inflammatory
  • Degenerative
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2
Q

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

A

2nd commonest

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3
Q

LOW BACK PAIN IS A SYMPTOM NOT A DIAGNOSIS

A

T

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4
Q

What is the prevalence of lower back pain?

A

60-90%

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5
Q

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

A

> 6 weeks

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6
Q

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

A

> 3 months

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7
Q

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

A
  • Musculoligamentous.
  • Lumbosacral.
  • Osteoporosis (minimal trauma).
  • Traumatic spondylolisthesis.
  • Post-op.
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8
Q

Suggest degenerative causes of lower back pain.

A
  • Disc disease.
  • Spondylolisthesis.
  • Spinal stenosis.
  • Facet joint arthrosis.
  • Scoliosis + structural.
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9
Q

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

A
  • Discitis.
  • Vertebral osteomyelitis.
  • Epidural abscess.
  • Paraspinal abscess.
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10
Q

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

A
  • Bony tumours – primary (myeloma) or metastatic (lung, breast).
  • Extradural tumours – lymphoma.
  • Intradural extramedullary – meningioma, neurofibroma.
  • Intradural intramedullary – ependymoma, astrocytoma etc.
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11
Q

Suggest inflammatory causes of lower back pain.

A
  • Sacroiliitis.
  • Ankylosing spondylitis.
  • Any rheumatological condition affecting the spine.
  • Arachnoiditis (post-meningitis, post-epidural).
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12
Q

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

A

T

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13
Q

What problems may cause referred pain to the lower back?

A
  • Aortic dissection.
  • Retroperitoneal disease – pancreas.
  • Perispinal disease ie. tumours and abscesses.
  • Ovarian/gynaecological problems.
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14
Q

Suggest non-organic causes of back pain.

A
  • Psychiatric.
  • Malingering (financial/emotional etc.).
  • Substance abuse.
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15
Q

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

A
  • Weight loss.
  • Fever/temperature/sweats.
  • Neck/arms/legs.
  • Bladder/bowel.
  • Cold extremities/non-healing ulcers.
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16
Q

What cancer gives you ‘night sweats’?

A

Lymphoma

17
Q

List the red flags of back pain.

A
  • 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
18
Q

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

A

A tumour – especially pancreatic cancer.

19
Q

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

A
  • 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.
20
Q

What do lumbar spine problems present with?

A

LEG PAIN&raquo_space;» back pain

21
Q

Outline the key clinical signs and symptoms in spinal stenosis.

A
  • Back pain > > Leg pain.
  • Brought about by WALKING.
  • Claudication distance.
  • Chronic bladder/bowel.
  • Gradual bilateral leg weakness.
  • +/- radicular pain.
22
Q

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

A
  • Back +/or leg pain.
  • Bilateral sciatica.
  • Bilateral leg weakness.
  • Acute bladder/bowel.
  • Painless bladder/bowel (VERY WORRYING).
  • Perineal numbness.
23
Q

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

A
  • X-ray.
  • CT.
  • MR.
24
Q

What is the best method for looking at suspected sciatica?

A

MRI - think about SSC

25
Q

What can be given to treat the nerve pain?

A

Amitriptyline / Gabapentin

26
Q

Paracetamol shows very little effect

A

T

27
Q

What is good for treating nerve pain?

A

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

28
Q

What advice should be given with regard to proper sitting?

A
  • Hips should be flexed.
  • Legs should not be extended.
  • Back should not be overly arched.
  • Sit for a MAXIMUM OF 30MINS.
29
Q

What advice should be given with regard to proper lifting?

A
  • Back kept erect.
  • Knees bent.
  • Weight close to body.
30
Q

Outline the management of lower back pain.

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

If none of this works - laminectomy

31
Q

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

A

Adequate pain relief

32
Q

What are the aims of physiotherapy?

A
  • Maintain flexibility.
  • Maintain free nerve roots.
  • Maintain muscle tone.
  • Maintain/restore core paraspinal muscle.
33
Q

What are the different techniques for physiotherapy?

A
  • 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)
34
Q

What is the function of the injections?

A

Long acting anaesthesia

35
Q

What are the 2 options of analgesia?

A
  • Facet joint injections

* Peri root injections

36
Q

What are decompression surgeries useful for?

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