Backpain 16/10/18 Flashcards
How are back problems assessed?
History Examination Social factors Occupational factors Litigation
What are causes of back pain?
Viscerogenic
Spondylogenic
Discogenic
neurogenic
What is a viscerogenic cause of back pain?
AAA
What are some other abdominal causes of back pain?
Gallbladder Pancreatic Renal Peptic ulcer Colonic Uterine
What are the symptoms of back pain?
Back pain
Leg pain
Neurological symptoms
What are two types of back pain?
Mechanical
Non-Mechanical
What are 3 presentations of back pain?
PSP - Possible spinal pathology
NRP - nerve root pain
MBP - MEchanical backpain
Back pain history?
SOCRATES
What are the two types of leg pain?
Referred
Root
What pattern does nerve root pain follow?
Dermatomal distribution
What type of pain is referred pain?
Dull
Buttocks/thigh
Rarely below knee
Ill defined sensory symptoms
What type of pain is root pain?
Sharp
Invariability below knee
Anatomical sensory/motor symptoms
What is sciatica?
ROOT leg pain
What are neurological symptoms associated with back pain?
Incontinence/loss of control or awareness
Perineal/saddle numbness
Bilateral/unilateral
Can have no leg ymptoms
What additional information is useful in back pain history?
Social
Age
Occupational factors
Litigation
what are some red flag signs for back pain?
Non-mechanical pain Systemic upset New neurological deficit Saddle anaesthesia Bladder or bowel upset
What are some possible spinal pathologies which can cause back pain?
Fracture
Tumours (secondary metastatic tumours)
Infection
Inflammatory - Ankylosing spondylitis
What cancers commonly metastasize to bone?
Breast Lung Renal Thyroid Kidney
What is the most common primary tumour in the spine?
Myeloma
what is the most common cause of fractures in the spine?
Osteoporotic
What features of a history would indicate at a tumour?
Weight loss Fatigue Bowel symptoms Renal symptoms Insidious onset No identifiable event Constant Night pain
What features f a history would indicate an infection?
Infection
Temperature
Fever
History of foreign travel
Have a look at a nerve root diagram because i have no fucking clue what is going on
xoxo gossip girl
what is the pathogenesis of disc prolapse?
Impaired disc nutrition
Disc prone to damage
Disc fissure - free fragments
Protrusion, extrusion, sequestration
What can accomodate a disc prolapse?
A large vertebral canal
What happens when a prolapse occurs in a small vertebral canal?
Root compression
Inflammatory markers
Root pain
Tension signs
What is the treatment for small vertebral canal disc prolapse?
Resolution
Surgery
What is the end result of acute disc prolapse?
Loss of disc height
Facet arthropathy
Back pain
+/- Canal Stenosis
What does degenerative disc disease cause?
Back pain
Stenosis or narrowing
When is back pain mechanical?
Diagnosis of exclusion
No nerve root problem
No underlying pathological process
What are some sources of back pain?
Sacroiliac joint
Facet joints
Muscle tears
What 2 conditions can cause mechanical back pain?
Spondylolysis
Spondylolisthesis
Where does spondylolisis occur?
Stress break along the transverse process of the vertebral body
What is looked for on back pain examination?
Straightness of spine
Forward bending
What is the normal profile of the spine?
Cervical Lordosis
Thoracic Kyphosis
Lumbar Lordosis
What can cause loss of lumbar lordosis?
Scoliosis
Ankylosing spondylitis
What 4 things are assessed on neurological examination?
Myotomes
Dermatomes
Reflexes
Nerve irritation
What are the respective myotomes for Hip, knee, foot and ankle movements?
L1/2 - Hip flexion
L3/4 - Knee extension
L5 - Foot dorsiflexion
S1/2 - Ankle plantarflexion
What does the straight leg raise test show?
Ability to burlesque
nerve root irritation - shooting pain
What is pain drawing?
The patient marks on a picture where they are experiencing pain
What is overt pain behaviour?
Guarding Bracing Rubbing Grimacing Sighing
What are behavioural responses to examination (Waddell)?
Superficial/Non anatomical tenderness Simulation - axial loading/rotation Distraction - SLR Over-reaction to examination Regional - sensory disturbance
What is a distraction test?
Get the patient to do a movement where they aren’t thinking about it that proves they are fine
- Can’t do straight leg test
- Ask them to sit up
What is an important examination to do in patients that have back pain?
PR examination
When is a PR examination appropriate?
Cauda equina syndrome
Are x-rays useful in back pain?
No in 99% of cases
When would a plain back x-ray be needed?
Worried about a PSP
Are MRI useful?
Not the answer
Mostly false positive
Double edged sword
What investigations are used to diagnose backpain?
MRI - but be careful` Diagnostic facet injection Contrast enhanced CT Provocation discography Selective nerve block/ablation
What is the spinal surgeon’s definition of sciatica?
Buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance
When is surgery done for disc prolapse?
Only done for leg pain
Will disc prolapse surgery improve neurology symptoms?
Not sure
Unpredictable
What are common presentations of disc prolapse?
Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dormant
Myotomes and dermatomes
Is disc prolapse an emergency?
No
How long will disc prolapse take to heal?
70% in 3 months
90% in 18-24 months
When is disc prolapse surgery required?
Suffering severly
Not healing within 3 months
How is backache managed?
Short bed rest Anti-inflammatory Muscle relaxant Mobilise Physical therapies Return to normal activities
What is the second line treatment for backache?
Education Physiotherapy osteopathy TENS Complementary therapies Surgery
Look at the back pain pathways
xoxo gossip girl
