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MSK lectures > Backpain 16/10/18 > Flashcards

Backpain 16/10/18 Flashcards

1
Q

How are back problems assessed?

A 
History
Examination
Social factors
Occupational factors
Litigation
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2
Q

What are causes of back pain?

A

Viscerogenic
Spondylogenic
Discogenic
neurogenic

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3
Q

What is a viscerogenic cause of back pain?

A

AAA

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4
Q

What are some other abdominal causes of back pain?

A 
Gallbladder
Pancreatic
Renal
Peptic ulcer
Colonic 
Uterine
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5
Q

What are the symptoms of back pain?

A

Back pain
Leg pain
Neurological symptoms

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6
Q

What are two types of back pain?

A

Mechanical

Non-Mechanical

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7
Q

What are 3 presentations of back pain?

A

PSP - Possible spinal pathology
NRP - nerve root pain
MBP - MEchanical backpain

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8
Q

Back pain history?

A

SOCRATES

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9
Q

What are the two types of leg pain?

A

Referred

Root

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10
Q

What pattern does nerve root pain follow?

A

Dermatomal distribution

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11
Q

What type of pain is referred pain?

A

Dull
Buttocks/thigh
Rarely below knee
Ill defined sensory symptoms

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12
Q

What type of pain is root pain?

A

Sharp
Invariability below knee
Anatomical sensory/motor symptoms

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13
Q

What is sciatica?

A

ROOT leg pain

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14
Q

What are neurological symptoms associated with back pain?

A

Incontinence/loss of control or awareness
Perineal/saddle numbness
Bilateral/unilateral
Can have no leg ymptoms

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15
Q

What additional information is useful in back pain history?

A

Social
Age
Occupational factors
Litigation

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16
Q

what are some red flag signs for back pain?

A 
Non-mechanical pain
Systemic upset
New neurological deficit
Saddle anaesthesia
Bladder or bowel upset
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17
Q

What are some possible spinal pathologies which can cause back pain?

A

Fracture
Tumours (secondary metastatic tumours)
Infection
Inflammatory - Ankylosing spondylitis

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18
Q

What cancers commonly metastasize to bone?

A 
Breast
Lung
Renal 
Thyroid 
Kidney
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19
Q

What is the most common primary tumour in the spine?

A

Myeloma

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20
Q

what is the most common cause of fractures in the spine?

A

Osteoporotic

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21
Q

What features of a history would indicate at a tumour?

A 
Weight loss
Fatigue
Bowel symptoms
Renal symptoms
Insidious onset
No identifiable event
Constant
Night pain
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22
Q

What features f a history would indicate an infection?

A

Infection
Temperature
Fever
History of foreign travel

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23
Q

Have a look at a nerve root diagram because i have no fucking clue what is going on

A

xoxo gossip girl

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24
Q

what is the pathogenesis of disc prolapse?

A

Impaired disc nutrition
Disc prone to damage
Disc fissure - free fragments
Protrusion, extrusion, sequestration

25
Q

What can accomodate a disc prolapse?

A

A large vertebral canal

26
Q

What happens when a prolapse occurs in a small vertebral canal?

A

Root compression
Inflammatory markers
Root pain
Tension signs

27
Q

What is the treatment for small vertebral canal disc prolapse?

A

Resolution

Surgery

28
Q

What is the end result of acute disc prolapse?

A

Loss of disc height
Facet arthropathy
Back pain
+/- Canal Stenosis

29
Q

What does degenerative disc disease cause?

A

Back pain

Stenosis or narrowing

30
Q

When is back pain mechanical?

A

Diagnosis of exclusion
No nerve root problem
No underlying pathological process

31
Q

What are some sources of back pain?

A

Sacroiliac joint
Facet joints
Muscle tears

32
Q

What 2 conditions can cause mechanical back pain?

A

Spondylolysis

Spondylolisthesis

33
Q

Where does spondylolisis occur?

A

Stress break along the transverse process of the vertebral body

34
Q

What is looked for on back pain examination?

A

Straightness of spine

Forward bending

35
Q

What is the normal profile of the spine?

A

Cervical Lordosis
Thoracic Kyphosis
Lumbar Lordosis

36
Q

What can cause loss of lumbar lordosis?

A

Scoliosis

Ankylosing spondylitis

37
Q

What 4 things are assessed on neurological examination?

A

Myotomes
Dermatomes
Reflexes
Nerve irritation

38
Q

What are the respective myotomes for Hip, knee, foot and ankle movements?

A

L1/2 - Hip flexion
L3/4 - Knee extension
L5 - Foot dorsiflexion
S1/2 - Ankle plantarflexion

39
Q

What does the straight leg raise test show?

A

Ability to burlesque

nerve root irritation - shooting pain

40
Q

What is pain drawing?

A

The patient marks on a picture where they are experiencing pain

41
Q

What is overt pain behaviour?

A 
Guarding
Bracing
Rubbing 
Grimacing
Sighing
42
Q

What are behavioural responses to examination (Waddell)?

A 
Superficial/Non anatomical tenderness
Simulation - axial loading/rotation
Distraction - SLR
Over-reaction to examination
Regional - sensory disturbance
43
Q

What is a distraction test?

A

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
44
Q

What is an important examination to do in patients that have back pain?

A

PR examination

45
Q

When is a PR examination appropriate?

A

Cauda equina syndrome

46
Q

Are x-rays useful in back pain?

A

No in 99% of cases

47
Q

When would a plain back x-ray be needed?

A

Worried about a PSP

48
Q

Are MRI useful?

A

Not the answer
Mostly false positive
Double edged sword

49
Q

What investigations are used to diagnose backpain?

A 
MRI - but be careful`
Diagnostic facet injection
Contrast enhanced CT
Provocation discography
Selective nerve block/ablation
50
Q

What is the spinal surgeon’s definition of sciatica?

A

Buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

51
Q

When is surgery done for disc prolapse?

A

Only done for leg pain

52
Q

Will disc prolapse surgery improve neurology symptoms?

A

Not sure

Unpredictable

53
Q

What are common presentations of disc prolapse?

A

Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dormant
Myotomes and dermatomes

54
Q

Is disc prolapse an emergency?

A

No

55
Q

How long will disc prolapse take to heal?

A

70% in 3 months

90% in 18-24 months

56
Q

When is disc prolapse surgery required?

A

Suffering severly

Not healing within 3 months

57
Q

How is backache managed?

A 
Short bed rest
Anti-inflammatory
Muscle relaxant
Mobilise
Physical therapies
Return to normal activities
58
Q

What is the second line treatment for backache?

A 
Education
Physiotherapy
osteopathy
TENS
Complementary therapies
Surgery
59
Q

Look at the back pain pathways

A

xoxo gossip girl

MSK lectures (50 decks)

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