back pain pearls

Question 1

back pain/

Pt w none of the red flag clinical clues/

imaging to do?

Answer 1

NONE!!

imaging will often find clinically unimportant abnormalities

Question 2

back pain/acute pain/

bed rest help??

Answer 2

No!

may prolong duration of pain.

Activity will not worsen the injury

Question 3

back pain/Suspected cauda equina syndrome/

medical emergency?

What to do if suspected?

Answer 3

Suspected cauda equina syndrome = medical emergency!

=>immediate imaging + decompression.

Question 4

back pain/

A straight leg raise test result=back pain only/

+ or - test?

Answer 4

negatif test

Question 5

back pain/

Cancer + back pain + neurologic abnormalities= emergency?

Answer 5

emergency!!

Question 6

back pain/

best imaging test to rule out back pain due to ca or

to c if there is cord compression?

Answer 6

MRI

Question 7

back pain/

best imaging test to distinguish malignant vs benign osteoporotic compression fractures.

Answer 7

MRI

Question 8

back pain/

best imaging test to rule OUT spinal stenosis?

Caveat?

Answer 8

CT and MRI scans/

stenosis visualised is not necessarily the one causing pts sx

Question 9

back pain/

dx can be PAD W/O typical sx + physical findings?

Answer 9

yeS!

Question 10

back pain/

always consider ??? in pt w

either vertebral osteomyelitis or a

spinal epidural abscess.

Answer 10

endocarditis

hint: osteomyelitis, spinal epidural abs often occ in IVDU or pt w immunosuppression=>

IVDU=> endocarditis is often present

Question 11

numbness w exertion +

improvement of pain when bending forward

/ suggests…

Answer 11

spinal stenosis

Question 12

vascular claudication/

onset?

Answer 12

Fixed walking distance b4 onset of sx:

hint: mm # of blood to muscle to get to the mm distance

Question 13

vascular claudication/

worsened by/improved by?

Answer 13

better: standing still (= no effort=> no blood coming in)
worse: walking or going uphill

Question 14

vascular claudication/

PE findings?

Answer 14

vascular: Absent pulses/
skin: shiny with loss of hair (no blood=> no food for the hair follicle)

Question 15

neurogenic claudication/

onset?

Answer 15

Variable walking distance/

hint: var bec it depends on the pressure on the spine during the effort

Question 16

*neurogenic claudication/

worsened by/improved by?

Answer 16

better: sitting or bending forward = flexion

(bend the spine=> does not squish the spinal cord )/

worse :walking or standing (upright position= extension)

Question 17

neurogenic claudication/

PE findings?

hint: vascular and skin/

comparred to vascular claudication

Answer 17

vascular= Present pulses

Skin: normal