Backache

Question 1

Red flags

Answer 1

TUNA FISH:
Trauma
Unexplained weight loss
Neurological deficit, night sweats or nocturnal pain 
Age <20 or >50
Fever
Incontinence and immunosuppression
Spinal tenderness 
History of malignancy

Question 2

Management of back pain

Answer 2

Be active
Regular paracetamol, NSAIDs +/- codeine
If above fails trial low dose amitryptyline
Offer physio, acupuncture and exercise programme
Address contributing psychosocial factors

Question 3

Signs of acute cauda equina syndrome

Answer 3

Bilateral root pain in legs
Saddle paresthesia
Decreased anal tone
Urine and/or faecal incontinence

Question 4

Signs of acute cord compression

Answer 4

Bilateral pain
LMN signs at spinal level
UMN signs and sensory loss below spinal level
Sphincter disturbance