Backache Flashcards
What features of the history are most important in backache?
Onset of pain Previous episodes Site and nature of pain Radiation of pain Neurological symptoms
SOCRATES
What social features of the history are important in diagnosing backache?
age
Occupation
Litigation (legal issues)
Why is it important to be aware of the patient who knows the exact time and date their back pain started?
Back pain = usually insidious in onset
=> someone who attributes all their back problems to a given event may have secondary issues
What features would be considered suspicious or “red flags” in a back pain history?
Non-mechanical pain
Systemic upset
Major OR new neurological deficit
Saddle anaesthesia +/- bladder or bowel upset
What types of physical tests can you carry out on examination?
Observation Range of movement Neurological assessment Nerve root irritation Distraction testing
What should you look for when observing the spine from the posterior and lateral sides?
deformity asymmetry hairy patches neurofibromata potential muscle spasm Normal lordosis and Kyphosis
During Schober’s test, what are the lower and upper limits of normal?
<18cm = pathologically stiff >24cm = hypermobile
What type of deformity is easily noticed on asking the patient to lean forward and touch their toes?
Scoliosis
spine appears rotated
What nerve roots are responsible for hip flexion?
L1/L2
What movements are nerve roots L3/4 responsible for?
Knee extension
What movement does the nerve root from L5 control?
Ankle dorsiflexion
What nerve roots are in control of plantar flexion of the foot?
S1/2
What examination tests nerve irritation?
Straight leg raise test
What movements do you test when doing a femoral stretch?
hip extension and knee flexion
to put as much pressure on femoral nerve as possible
What characteristics are considered “overt” pain behaviour?
Guarding Bracing Rubbing Grimacing Sighing
