Back pain & Sciatica Flashcards
What are important things to ask about in a presenting complaint of back pain?
- onset
- character (dull, stabbing, throbbing)
- location and radiation (buttocks, below knee)
- duration (acute vs. subacute vs. chronic >1 year)
- intensity
- associated symptoms (stiffness, numbness, urinary symptoms)
- aggravating factors (position, valsalva, stairs)
- relieving factors (position, analgesia, alternative)
State the points to include in systemic review
Fever, weight loss, abdominal pain, cough, haematuria, dysuria, menstruation
What drugs are important to note in a history?
Corticosteroids, immunosuppressants, anti-platelet/coagulation
What should you ask about family history?
Cancers
Back pain
Spondyloarthropathies
What should be included in social history
Occupation
Smoking
Recreational drug use
Sporting activities
State the general red flags for back pain
Failure to improve after 4-6 weeks of conservative therapy, night pain/pain at rest, motor/sensory deficit
Name the cancer red flags for back pain
Age >50, weight loss, history of cancer, pain at night/rest
State the infection red flags
Fever/chills, recent infection, immunosuppression, IV drug use, dental status, foreign travel
What are the fracture red flags?
> 50 years old, osteoporosis, trauma, chronic steroid use
Name the red flags for cauda equina
Bilateral sciatica, urinary incontinence, decreased anal tone, saddle anaesthesia, leg weakness
What are the red flags for AAA?
Age >60, abdominal pulsating mass, pain at rest
State the additional tests in a spinal examination
Straight leg raise
Muscle strength
Sensation
Deep tendon reflexes
What is Hoffmans Test?
Flick nail of middle finger, positive if flexion of the thumb/index finger occurs
What is the babinski test?
Run a sharp instrument down the centre of the foot and normally toes should flex but in pathology toes will extend
What percentage of back pain will resolve within a month?
70-90%
