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Week A11 - MSK > Back Pain & Spinal Disorders > Flashcards

Back Pain & Spinal Disorders Flashcards

1
Q

What are the generalised causes of back pain? [5]

A
  1. Mechanical wear & tear (97%)
    • = non-specific low back pain (NSLBP)
  2. Systemic
    • Infection
    • Malignancy
    • Inflammatory
  3. Referred (i.e. no pathology in back)
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2
Q

What are the clinical features of “mechanical” back pain/non-specific low back pain (NSLBP)? [4]

A
  1. Onset at any age, variable rate
  2. Generally worsens with movement or prolonged standing
  3. Better with rest
  4. Early morning stiffness <30mins
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3
Q

What are the causes of mechanical back pain? [6]

A
  1. Lumbar strain/sprain
    • most common cause
    • muscle spasms usually settle 24-48hrs
  2. Degenerative disc disease (“spondolysis”)
    • many = asymptomatic disc disease
    • increase with flexion, sitting, sneezing
  3. Degenerative facets joint disease
    • more localised
    • increase with extension
  4. Disc prolapse
  5. Spinal stenosis
  6. Compression fractures
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4
Q

How do you manage mechanical back pain? [5]

A
  1. Keep diagnosis under review
  2. Reassurance
  3. Education, promote self-management
    • advise to stay active
    • exercise programme and physiotherapy
  4. Analgesics as appropriate (avoid opiates)
  5. Also acupuncture
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5
Q

What is a disc prolapse? [1]

A

herniated nucleus pulposus

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6
Q

Where is the pain generally found in a disc prolapse? [2]

A

leg → back pain

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7
Q

What examination tests are done on a patient with suspected disc prolapse and what would these show? [2]

A
  1. test reflexes: ↓reduced reflexes
  2. straight leg test: would test +ve
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8
Q

What is a positive straight leg test?

A

pain between 30-70°

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9
Q

In which direction does the nucleus pulposus tend to prolapse (anteriorly/posteriorly/superiorly/inferiorly)? [1]

A

posteriorly

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10
Q

What are the symptoms of cauda equina? [4]

A
  1. Neuropathic symptoms
    • bilateral sciatica
    • saddle anaesthesia
  2. Bladder or bowel dysfunction
    • reduced anal tone
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11
Q

What is cauda equina usually caused by? [1]

A

a large prolapsed disc

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12
Q

What is spinal stenosis? [2]

A

Anatomical narrowing of spinal canal that can be congenital and/or degenerative

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13
Q

What does spinal stenosis often present with? [1]

A

Often presents with “claudication” in legs/calves

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14
Q

What is spondylolisthesis and where does it usually occur?

A
  1. “slip” of one vertebra on the one below - anterior displacement of a vertebral disc
  2. often at L5 level
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15
Q

Describe the pain that is commonly present in spondylolisthesis [2]

A
  1. Pain may radiate to posterior thigh
  2. Increase with extension
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16
Q

What are the presenting features of compression fracture? [3]

A
  1. Often sudden severe onset of pain
  2. Radiates in “belt” around chest/abdomen
  3. Associated osteoporosis
17
Q

What investigations would you do on a patient with a suspected compression fracture? [2]

A
  1. X-ray
  2. DEXA scan
18
Q

What are the causes of referred back pain? [6]

A
  1. Aortic aneurysm
  2. Acute pancreatitis
  3. Peptic ulcer disease (duodenal)
  4. Acute pyelonephritis/Renal colic
  5. Endometriosis/gynae
19
Q

What are the distinctive presenting features of an aortic aneurysm? [3]

A
  1. CVS features (BP, THR)
  2. collapse,
  3. pulsating abdominal mass
20
Q

What are the distinctive presenting features of acute pancreatitis? [3]

A
  1. epigastric pain,
  2. relief if lean forwards,
  3. unwell
21
Q

What are the distinctive presenting features of peptic (duodenal) ulcer disease? [4]

A
  1. epigastric pain (after meals),
  2. history of peptic ulcer disease,
  3. vomit,
  4. blood/melaena
22
Q

What are the distinctive presenting features of acute pyelonephritis/renal colic? [6]

A
  1. history of UTI
  2. history of stones,
  3. unwell,
  4. radiation,
  5. haematuria,
  6. frequency
23
Q

What are the systemic causes of back pain? [3]

A
  1. Infection — discitis, osteomyelitis, epidural abscess
  2. Malignancy
  3. Inflammatory
24
Q

Describe infective discitis under the following headings:

  1. signs & symptoms? [4]
  2. who gets it? [3]
  3. investigations? [3]
  4. microbiological causes? [1]
  5. treatment options? [2]
A
  1. Signs & Symptoms:
    • High index of suspicion
    • Fever (may be PUO),
    • Weight loss
    • Constant back pain — rest, night pain
  2. Who gets it?
    • Immunosuppressed,
    • Diabetics,
    • IV drug users
  3. Investigations:
    • Bloods: FBC, ESR, CRP, blood cultures
    • Imaging x-ray (end-plate/vertebral destruction), MRI
    • Radiology-guided aspiration
      • Look for the source
  4. Microbiological causes:
    • Most commonly Staph aureus
  5. Treatment:
    • IV antibiotics
    • ± surgical debridement
25
Q

Describe the features of malignancy as a systemic cause of back pain under the following headings:

  1. risk factors/which maligancies put u at increased risk? [5]
  2. typical age of onset? [1]
  3. signs & symptoms? [4]
  4. investigations? [3]
A
  1. Risk factors:
    • History of malignancy: “LP Thomas Knows Best”
      • lung,
      • prostate,
      • thyroid,
      • kidney,
      • breast
  2. Onset age >50yrs
  3. Signs & Symptoms:
    • Constant pain, often worse at night
    • Systemic symptoms
    • Primary tumour signs & symptoms
  4. Investigations:
    • X-ray (lytic/destructive),
    • MRI,
    • bone scan
    • look for primary source
26
Q

Describe the features of inflammatory back pain under the following headings:

  1. age of onset? [1]
  2. signs & symptoms? [5]
A
  1. Onset <45 years (often teens)
  2. Signs & symptoms:
    • Early morning stiffness >30mins
    • Back stiff after rest & improves with movement
    • May wake 2nd half night
    • Buttock pain
27
Q

What are the red flags associated with back pain?

  • symptoms? [10]
  • signs? [5]
A
  • Symptoms:
    1. New onset age <16 or >50
    2. Following significant trauma
    3. Previous malignancy
    4. Systemic = fevers/rigors, general malaise, weight loss
    5. Previous steroid use
    6. IV drug abuse, HIV or immunosuppressed
    7. Recent significant infection
    8. Urinary retention
    9. Non-mechanical pain (worse at rest “night pain”)
    10. Thoracic spine pain
  • Signs:
    1. Saddle anaesthesia
    2. Reduced anal tone
    3. Hip or knee weakness
    4. Generalised neurological deficit
    5. Progressive spinal deformity
28
Q

What are the yellow flags associated with back pain? [7]

A
  1. Attitudes
    • towards the current problem.
  2. Beliefs
    • misguided belief that they have something serious
  3. Compensation
    • awaiting payment for an accident/ RTA?
  4. Diagnosis
    • inappropriate communication, patients misunderstanding what is meant,
    • examples being ‘your disc has popped out’ or ‘your spine is crumbling’.
  5. Emotions
    • other emotional difficulties e.g. depression/ anxiety
  6. Family
    • either over bearing or under supportive.
  7. + Work relationship
29
Q

Describe the differences between mechanical vs. inflammatory back pain under the following headings:

  1. age of onset? [2]
  2. features of onset? [3]
  3. duration of morning stiffness? [2]
  4. effect of exercise? [2]
  5. effect of rest? [2]
  6. symptoms at night-time? [2]
A
  1. age of onset
    • mechanical = any age
    • inflammatory = usually <40yrs
  2. features of onset
    • mechanical = variable, may be acute
    • inflammatory = insidious
  3. duration of morning stiffness
    • mechanical = <30mins
    • inflammatory = >30mins
  4. effect of exercise
    • mechanical = may worsen pain
    • inflammatory = improves pain & stiffness
  5. effect of rest
    • mechanical = often improves
    • inflammatory = no improvement
  6. symptoms at night-time
    • mechanical = may improve
    • inflammatory = may wake during second half of night

Week A11 - MSK (13 decks)

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