Bones and joint

Question 1

What’s the first key question in management of low back pain?

Answer 1

Is there associated neurology

Question 2

If someone has low back pain without neurology, what should you consider next?

Answer 2

Are there any red flags

Question 3

In what situations in a pain xray indicated in assessment of low back pain?

Answer 3

• Red flags (excluding neurology)

- Pain not responding to conservative treatment

Question 4

What conditions should you be considering in low back pain with neurology?

Answer 4

• Radiculopathy/sciatic
• Possible cord or cauda equina compression
• Spinal canal stenosis

Question 5

Which suspected condition should warrant urgent imaging, and with which?

Answer 5

Cord or cauda equina compression

Question 6

In what situations is an MRI indicated for low back pain?

Answer 6

1. Post plain xray with cause for pain still uncertain
2. Radiculopathy pain not improving
3. Suspected cord compression (urgently)
4. Suspected spinal canal stenosis

Question 7

In what situations is a CT back indicated?

Answer 7

When an MRI is indicated for investigation but unavailable or CI for another reason

Question 8

In what situations is a bone scan of the back indicated?

Answer 8

Suspected bony metastases or multifocal infection

Question 9

Who should be screened for OP with a DEXA scan?

Answer 9

People over 70

People over 50 with rf*

Question 10

What rf mean someone over 50 should get DEXA screening?

Answer 10

• 1’ relative FHx
• Early menopause
• Hypogonadism
• 3/12+ of CCS
• Malabsorptive disorders
• RA
• 1’ hyperPTH
• Hyperthyroidism
• CKD
• CLD
• Androgen deprivation Tx

Question 11

What tests should you do to Ix the cause of OP?

Answer 11

• UEC
• CMP
• Vit D
• TFTs
• PTH
• Serum/urine electrophoresis
• +/- Testosterone levels