Chapter 24, Module 6; Lower back pain (acute) Flashcards
Trauma to spine or back; pain is felt near site of injury
Spinal fracture
Palpable tenderness over site of fracture
Spinal fracture
DIAGNOSTIC STUDIES of Spinal fracture
Considered an emergency; immobilize patient and transport for radiographs
History of cancer; progressive pain is unremitting; occurs at night and at rest
Tumor
Weight loss, fever, tenderness near tumor
Tumor
DIAGNOSTIC STUDIES OF tumor
ESR; bone scan
Neck or back pain not relieved by aspirin; occurs in older adolescents and young adults
Osteoblastoma
Localized tenderness; may have scoliosis with muscle pain
Osteoblastoma
DIAGNOSTIC STUDIES OF Osteoblastoma?
Plain film shows an expansive osteolytic lesion surrounded by thin peripheral rim of bone; bone scan; CT scan
Occurs primarily in adolescents; rare in patients older than age 40; well- localized pain that may be more se¬ were at night and relieved by aspirin or other prostaglandin inhibitors
Osteoid osteoma
Painful, well-localized scoliosis may be present
Osteoid osteoma
DIAGNOSTIC STUDIES OF Osteoid osteoma?
Bone scan
History of infection, invasive procedure; continuous, dull back pain; chronic back pain
Infection (vertebral osteomyelitis)
Acute onset with fever, diaphoresis; tenderness over affected disk; positive SLR
Infection (vertebral osteomyelitis)
DIAGNOSTIC STUDIES OF Infection (vertebral osteomyelitis)?
ESR; blood culture; bone biopsy; CT scan; MRI
Pain aggravated by movement; more common in children
Diskitis
Tenderness over affected disk
Diskitis
DIAGNOSTIC STUDIES OF Diskitis?
ESR
LBP radiating down the buttock to below the knee, symptoms present less than 1 mo
Herniated disk
Positive SLR
Herniated disk
DIAGNOSTIC STUDIES OF Herniated disk ?
None
Constant pain in a saddle distribution; urinary retention, fecal incontinence, radiculopathy
Cauda equina syndrome
Positive SLR, abnormal DTRs, motor weakness
Cauda equina syndrome
DIAGNOSTIC STUDIES OF Cauda equina syndrome?
MRI, surgical emergency
Acute back pain with radiculopathy; history of strain or trauma, relief with sitting
Sciatica
Paravertebral tenderness and spasm; positive SLR; sitting knee extension, sensory findings
Sciatica
DIAGNOSTIC STUDIES OF Sciatica?
EMG if chronic
Pain in back, buttocks; history of new activity or exertion; relief of pain with sitting
Musculoskeletal strain
Paravertebral tenderness, scoliosis, or loss of lumbar lordosis; no neurological signs
Musculoskeletal strain
DIAGNOSTIC STUDIES OF Musculoskeletal strain?
None
Young person in a sport that demands rapid movement between hyperflexion and hyperextension or requires excess loading in hyperextension
Spondylolisthesis
No neurological signs; pain localized to low back, just below level of iliac crest; tight hamstrings
Spondylolisthesis
DIAGNOSTIC STUDIES OF Spondylolisthesis?
Lumbar spine radiographs
Younger than age 40: insidious onset; progressive morning back pain relieved with exercise
Ankylosing spondylitis
Painful sacroiliac joints, reduced spine mobility; may have uveitis
Ankylosing spondylitis
DIAGNOSTIC STUDIES OF
ESR; spinal radiographs
Pain worse throughout day; aggravated by standing, relieved by rest; pseudoclaudication
Spinal stenosis
Signs of osteoarthritis of joints; may have neurological signs
Spinal stenosis
DIAGNOSTIC STUDIES OF Spinal stenosis?
None
Affects mostly adolescent males; mild to moderately severe pain, worse at end of day, relieved by rest
Scheuermann disease
Normal examination; may show an exaggerated thoracic kyphosis that is fixed in attemptedhyperextension
Scheuermann disease
DIAGNOSTIC STUDIES OF Scheuermann disease?
Thoracic spine radiographs
Chronic, poorly localized back pain; postmenopausal; slight build; history of inactivity or endocrine disorder
Osteoporosis
Palpable tenderness over area of compression fracture; kyphosis or lordosis; loss of height
Osteoporosis
DIAGNOSTIC STUDIES OF Osteoporosis?
Bone densitometry; spinal radiograph to assess fracture
Severe, acute-onset pain not related to activity or movement; increased risk older than age 30; pallor, diaphoresis, anxiety, confusion
Aortic aneurysm
Intact aneurysm will be a visible pulsatile midline upper quadrant abdominal mass; in a dissected aneurysm, upper extremity pulse and pulse pressures are asymmetric; posterior thoracic pain may be felt
Aortic aneurysm
DIAGNOSTIC STUDIES OF Aortic aneurysm?
Emergency surgical referral
Increased incidence with age; steady, intense pain in RUQ with radiation to right scapula or shoulder; belching, bloating, fatty food intolerance
Gallstones
Normal physical examination or positive Murphy sign on palpation of abdomen
Gallstones
DIAGNOSTIC STUDIES OF Gallstones?
Surgical referral
Ill-appearing; sweating, nausea, back or flank pain, headache
Pyelonephritis
Fever; cloudy, malodorous urine; CVA tenderness on percussion
Pyelonephritis
DIAGNOSTIC STUDIES OF Pyelonephritis?
Urinalysis; urine culture
History of recent URI; pleuritic pain
Pleuritis
Normal examination or crackles and bronchial breath sounds
Pleuritis
DIAGNOSTIC STUDIES OF Pleuritis?
PPD; chest radiograph
Sexually active female; low back and abdominal pain; history of urinary or vaginal symptoms, sexually transmitted disease, IUD, multiple sex partners
Pelvic inflammatory disease
Cervical and uterine motion tenderness, adnexal tenderness; cervicitis, fever
Pelvic inflammatory disease
DIAGNOSTIC STUDIES OF Pelvic inflammatory disease?
Gonorrhea, Chlamydia cultures; ESR
History of psychosocial stressors,depression, exaggerated expressions of pain
Psychologicalback pain
Exaggerated or inconsistent reactions to testing; normal examination
Psychologicalback pain
DIAGNOSTIC STUDIES OF Psychologicalback pain?
none