back pain + sciatica Flashcards

1
Q

lumbago

A

low back pain

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2
Q

acute low back pain should improve within…

A

1-2wks

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3
Q

sciatica recovery time

A

4-6wks

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4
Q

management aims for lower back pain

A
  • identify serious underlying pathology
  • speed up recovery
  • reduce risk chronic lower back pain
  • manage Sx in chronic LBP
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5
Q

caused of mechanical back pain

A
muscle/ligament sprain 
facet joint dysfunction 
SI joint dysfunction 
herniated disc
spondylolithesis 
scoliosis 
degenerative changes
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6
Q

causes of neck pain

A

muscle/ligament sprain
torticollis
whiplash
cervical spondylosis

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7
Q

torticollis

A

waking up with a unilaterally stiff and painful neck due to muscle spasm

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8
Q

red flag causes of back pain

A

spinal fracture - major trauma
cauda equina - saddle anaesthetsia, incontinence, bilateral neuro signs
ankylosing spondylitis
spinal infection - fever, Hx IVDU

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9
Q

causes of back pain which are unrelated to spine

A
pneumonia 
ruptured AAA
kidney stone 
pyelonephritis
pancreatitis
prostatitis
PID 
endometriosis
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10
Q

sciatic nerve - nerve roots

A

L4-S3

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11
Q

sciatic nerve - exitrs posterior pelvis through

A

greater sciatic foramen

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12
Q

sciatic nerve - divides into

A

tibial nerve
common peroneal nerve

(at knee)

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13
Q

sciatic nerve - sensory function

A

lateral lower leg and foot

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14
Q

sciatic nerve - motor function

A

posterior thigh

lower leg and foot

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15
Q

sciatia - presentation

A

unilateral buttock pain radiating down leg
paraesthesia
numbness
motor weakness

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16
Q

sciatica main cause

A

lumbosacral nerve root compression

  • herniated disc
  • spondylolithesis
  • spinal stenosis
17
Q

bilateral sciatica

A

red flad for cauda equina syndrome

18
Q

examination findinfs - localised spinal tenderness

A

spinal #

cancer

19
Q

examination findinfs -bilateral neuro signs

A

cauda equina

20
Q

examination findinfs -bladder distension

A

urinary retention - cauda equina

21
Q

examination findinfs -reduced anal tone

A

cauda equine

22
Q

Ix - spinal fracture

A

X-ray or CT

23
Q

Ix - suspected cauda equina

A

emergency MRI

24
Q

Ix - ankylosing spondylitis

A

inflammatory markers - CRP, ESR
X-ray (bamboo spine)
MRI

25
Q

STarT back screening tool

A

risk of patient presenting with acute back pain developing chronic back pain

26
Q

managing acute lower back pain - first steps

A
  1. exclude serious underlying cause

2. StarT back tool

27
Q

Mx acute back pain - pt at low risk of chronic back pain

A
self management 
education 
reassurance 
analgesia
staying active, mobilisation
28
Q

Mx acute back pain - pt at med/high risk of chronic back pain

A

physiotherapy
group exercise
CBT

29
Q

Mx acute back pain - analgesia

A
  1. NSAIDS first line
  2. codeine as alternative
  3. benzodiazepines for muscle space (short term up to 5days)
30
Q

Mx acute back pain - analgesia NOT to use

A
opioids
antidepressants
amitryptiline 
gabamentin 
pregabalin
31
Q

Mx chronic lower back pain from facet joints

A

radiofrequency denervation

32
Q

sciatica - pain Mx

A

amitryptiline

duloxetine

33
Q

sciatica - specialist Mx options

A

epidural corticosteroid infections
local anaesthetic injectins
radiofrequency denervation
spinal decompression