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Neurology > Back Pain and Sciatica > Flashcards

Back Pain and Sciatica Flashcards

1
Q

what is buttock pain likely to be

A

muscular

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2
Q

what is back pain going to below the knee likely to be

A

nerve- disc problem

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3
Q

what are the general red flags for back pain

A

general

  • failure to improve after 4-6 of conservative treatment
  • unrelenting night pain or pain at rest
  • progressive motor or sensory deficit
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4
Q

what are the cancer red flags in back pain

A

cancer

  • age > 50
  • unintentional weight loss
  • Hx of cancer
  • pain at night and in recumbency
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5
Q

what are the infection back pain red flags

A

infection

  • fever/ chills
  • recent infection
  • immunosuppression
  • IV drug use
  • dental status
  • foreign travel
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6
Q

what are the cauda equina red flags

A
  • Bilateral sciatica
  • Urinary incontinence
  • Leg weakness
  • Absent anal tone
  • Loss of perianal sensation
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7
Q

what are the red flags for fracture in back pain

A
  • age > 50
  • osteoporosis
  • significant trauma
  • chronic steroid use
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8
Q

what are the res flags for AAA in back pain

A
  • age > 60
  • abdominal pulsating mass
  • pain at rest
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9
Q

what root levels:

hip flexion

A

L2,3

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10
Q

what root levels:

hip extension

A

L4,5

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11
Q

what root levels:

knee extension

A

L3,4

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12
Q

what root levels:

Knee flexion

A

L5,S1

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13
Q

what root levels:

ankle dorsiflexion

A

L4,5

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14
Q

what root levels:

ankle plantarflexion

A

S1,2

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15
Q

what root levels:

foot eversion

A

L5,S1

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16
Q

what root levels:

foot inversion

A

L4

17
Q

what are the MRC muscle power grades

A

0- complete paralysis
1- flicker of contraction possible
2- movement possible if gravity eliminated
3- movement against gravity but not resistance
4- movement possible against some resistance
5- power normal

18
Q

do you need to investigate all back pain

A

no 70-90% are innocent, resolve in a month with conservative Tx

19
Q

when should you do an x ray

A

do not x ray routinely
except in
- young men at SI joint to exclude ank spon
- elderly to exclude vertebral fractures, collapse, malignancy
-for deformity correction surgeries

20
Q

what are CT scans good for

A

bony pathology- trauma, tumours, infection)

  • good for foreign bodies, implants
  • spinal fusion planning
  • if MRI contraindicated/ not available
  • limited use in acute LBP unless red flags
21
Q

what is MRI good for

A

red flags in back pain= MRI
neurological signs/ symptoms= MRI

  • soft tissue (inc tumours and infection)
  • some sequences good for new fractures
  • bone oedema/ microfractures
22
Q

what do radionucleotide scans show

A

increased bone turnover (tumours, pagets, fractures, osteomyelitis, ank spon, mets, osteoid osteoma)

23
Q

what does a PET scan show

A

increased uptake in high turnover areas

24
Q

when do you do lab tests in back pain

A

when red flags present

  • malignancy (PSA, acid phosphate, monoclonal bands)
  • infection
  • metabolic causes (alk phos, Ca2+ etc)
25
Q

what is the treatment for back pain

A

aim to relieve pain and find underlying cause

  • explanation, reassurance, advice on activity and exercise, NO BED REST
  • WHO pain ladder
  • facet joint/ epidural injections for pain relief
  • complementary and alternative mechanisms (acupuncture, chiropracture, osteopath, massages, PHYSIOTHERAPISTS)
26
Q

what do you investigate back pain

A

no improvement in 4-6 weeks

any red flags

27
Q

when do you refer back pain

A
  • intractable pain
  • serious pathology suspected or suggested on initial imaging
  • neurological deficit
28
Q

what are the risk factors for mechanical back pain

A

previous back pain
heavy lifting/ frequent bending
repetitive work with exposure to vibration

29
Q

how do you prevent mechanical back pain

A

education- lifting, turning etc, mental coping strategies, stopping smoking
maintain physical activity

30
Q

what are the differential for causes of sciatic back

A
  • root compression by degenerative causes (bone spurs, canal stenosis, spondylolisthesis, facet arthropathy)
  • root compression of sinister causes (tumour, fractures, TB)
  • root compression of sinister causes (tumour, #, TB)
  • root compression outside the spine (piriformis syndrome, endometriosis, pelvic disease, peroneal compression)
  • no root compression (arachnoiditis, peripheral neuropathies)
31
Q

what is piriformis syndrome

A

when the sciatic nerve goes through the piriformis muscle which can compress the nerve

32
Q

is sciatic permanent

A

no generally self limiting

Neurology (35 decks)

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