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Musculoskeletal > Back Pain and Spinal Disorders > Flashcards

Back Pain and Spinal Disorders Flashcards

1
Q

What are the possible psychological effects of back pain?

A

Emotional stress
Relationship breakdown
Severe emotional distress for partners
Limitations in fulfilling family tasks

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2
Q

At what stage is back pain classified as chronic?

A

> 3 months

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3
Q

What structures may be the source of back pain?

A 
Ligaments
Facet joints
Paravertebral muscles and fascia
Discs 
Spinal nerve roots
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4
Q

What is the broad differential for back pain?

A

Mechanical
Systemic (infection, malignancy, inflammatory)
Referred

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5
Q

Compare and contrast mechanical and inflammatory back pain?

A

Mechanical can occur at any age, has a variable onset, <30 mins morning stiffness, exercise often worsens pain, rest often improves pain and pain may improve at night
Inflammatory usually occurs <40 years, has an insidious onset, >30mins morning stiffness, exercise improves pain with no improvement on rest and may have night pain

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6
Q

What are the possible causes of non-specific low back pain?

A 
Lumbar strain/sprain
Degenerative disc disease
Degenerative facet joint disease
Disc prolapse
Spinal stenosis
Compression fractures
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7
Q

How should non-specific low back pain be managed?

A

Exercise programmes
Physiotherapy
Patient education
Analgesia - but avoid opiates

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8
Q

Which part of the intervertebral disc herniates in a disc prolapse?

A

Nucleous pulposus

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9
Q

Leg pain is worse than back pain in disc prolapse. T/F?

A

True

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10
Q

Most disc prolapses will resolve spontaneously within how many weeks?

A

12 weeks

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11
Q

Surgery for disc prolapse helps only the back pain and not the leg pain. T/F?

A

False - it only helps the leg pain

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12
Q

What is the most common cause of caudal equina syndrome?

A

large disc prolapse

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13
Q

What are the signs/symptoms of caudal equina syndrome?

A

Neuropathic symptoms of bilateral sciatica and saddle anaesthesia
Bladder or bowel dysfunction with reduced anal tone

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14
Q

What is spinal stenosis?

A

An anatomical narrowing of the spinal canal which can be congenital or degeneration

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15
Q

Describe the typical presentation of spinal stenosis

A

Claudication in the legs and calves which is worse with walking and resting in the flexed position

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16
Q

How is spinal stenosis investigated?

A

X-Ray

MRI

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17
Q

What is spondylolithiasis?

A

A ‘slip’ of one vertebra on to the one below

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18
Q

Spondylithiasis is often asymptomatic. T/F?

A

True

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19
Q

Where does pain commonly radiate to in spondylolithesis?

A

Posterior thigh

Increases with extension

20
Q

What groups of patients commonly get compression fractures?

A

Elderly patients

21
Q

Where does the pain radiate to in compression fractures?

A

Radiates in a ‘belt’ around the chest and abdomen

22
Q

What condition is associated with compression fractures?

A

Osteoporosis

23
Q

How are compression fractures treated?

A

Analgesia
Calcitonin
Vertebroplasty (cement)
Kyphoplasty (balloon)

24
Q

How are compression fractures investigated?

A

X-Ray

DEXA scan

25
Q

How soon after a lumbar sprain/strain do muscle spasms usually settle?

A

24-48 hours

26
Q

What positions or movements increase pain in degenerative disc disease?

A

Flexion
Sitting
Sneezing

27
Q

What positions or movements increase pain in degenerative facet joint disease?

A

Extension

28
Q

What pathologies can cause referred pain in the back?

A 
Aortic aneurysm
Acute pancreatitis
Peptic ulcer disease
Acute pyelonephritis / renal colic
Endometriosis
29
Q

What are the signs and symptoms of an aortic aneurysm?

A

CVS features such as increased bp and heart rate

Pulsating abdomen mass

30
Q

What are the signs and symptoms of an acute pancreatitis?

A

Epigastric pain
Relief when leaning forwards
Unwell

31
Q

What are the signs and symptoms of peptic ulcer disease?

A

Epigastric pain
History of PUD
Vomit
Blood/malaena

32
Q

What are the signs and symptoms of acute polynephritis or renal colic?

A 
History of UTI
Unwell
Radiation
Haematuria
Frequency
33
Q

What are the signs and symptoms of infective discitis?

A

Fever
Weight loss
Constant back pain even at rest and at night

34
Q

What is the most common causative organism of infective discitis?

A

S.aureus

35
Q

How should possible infective discitis be investigated?

A

Bloods - FBC, ESR, CRP, blood cultures
X-Ray
MRI
Radiology guided aspiration

36
Q

How is infective discitis treated?

A

IV antibiotics

Surgical debridement

37
Q

What patients are most at risk of infective discitis?

A

Immuosuppressed
Diabetic patients
IVDUs

38
Q

Malignancies of which organs can cause back pain?

A 
Lung
Prostate
Thyroid
Kidney
Breast
39
Q

Malignancy often causes constant back pain which is often worse at night. T/F?

A

True

40
Q

In what age group does inflammatory back pain usually occur?

A

Patients <45 years

41
Q

Describe the New York Criteria for ankylosing spondylitis?

A

Clinical criteria: low back pain and stiffness for more than 3 months which improves with exercise, but is not relieved by rest
Limitation of motion of the lumbar spine in both the sagittal and frontal planes
Limitation fo chest expansion relative to normal values correlated for age and sex
Sacroilitis grade >2 bilaterally or grade 3-4 unilaterally

42
Q

What are the symptoms of axial spondyloarthritis?

A

Inflammatory back pain
Fatigue
Arthritis in other joints: hips, knees
Enthesitis: achilles tendon, plantar fasciitis
Inflammation outside the joints - uveitis, psoriasis, churn’s disease, inflammation of heart/lungs

43
Q

Which gene can predispose to ankylosing spondylitis or axial spondyloarthritis?

A

HLA-B27 gene

44
Q

How is inflammatory back pain treated?

A 
NSAIDs
Biologic drugs
Education
Exercise
Physical therapy
Rehabilitation
Self-help groups
45
Q

What are the red flag symptoms of back pain?

A 
New onset <16 or >50 years
Following significant trauma
Previous malignancy
Systemic - fevers, riggers, general malaise, weight loss
Previous steroid use
IV drug abuse, HIV or immuocompromised
Recent significant infection
Urinary retention
Non-mechanical pain
Thoracic spine pain
46
Q

What are the red flag signs of back pain?

A 
Saddle anaesthesia
Reduced anal tone
Hip or knee weakness
Generalised neurological deficit
Progressive spinal deformity
47
Q

What are the yellow flag signs of back pain?

A

Bio-psycho social model to assess patients likely to develop chronicity:
Attitudes, beliefs, compensation, diagnosis, emotions, family, word relationship

Musculoskeletal (11 decks)

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