Clinical Reasoning Case Study 2 Flashcards
Types of Back Pain
Nocioceptive Pain, Somatic Referred Pain, Radicular Pain, Radiculopathy
Nocioceptive Pain
Pain that is evoked by noxious stimulation of structures or tissues.
-Noxious: Damage to tissue, does not necessarily cause pain. (Usually a dull, achy pain if there is pain present)
Somatic Referred Pain
-Produced by noxious stimulation of nerve endings within spinal structures (discs, zygopophaseal joints, SI joints)
-Pain spreads into the lower limbs, lies in the somatic tissues of the lumbar spine (center over gluteal region/proximal thigh and extend to the foot)
-Dull, aching, gnawing and sometimes expanding pressure
Radicular Pain
-Pain evoked by ectopic discharges emanating from a dorsal root or its ganglion
-Disc herniation is the most common cause
-Inflammation of affected nerve (or previously inflamed)
-Only type of pain produced by stimulating nerve roots,
-Travel the length of the lower limb
-Pain is lancinating, shocking, electric
Radiculopathy
-Blockage of spinal nerve or it’s nerve roots
-Causes numbness (dermatomal), weakness (myotomal), diminished reflexes
-Not defined by pain
Somatic referred pain is often misdiagnosed as ___________
Radicular pain
Categories of Disc Herniation
Disc Protrusion, Disc Sequestration, Disc Extrusion
Disc Protrusion
Depth of the herniation is less than the base of the herniation
Disc Extrusion
Depth of the herniation is larger than the base of the Herniation
Disc Sequestration
Extruded Disc has no continuity with the disc of origin
Risk factors of disc herniation
Genetic, lumbar loads, exercise, smoking, obesity, taller than 6’3”
Herniated Disc & Sciatica Recovery
-55-73% w/o surgery after 12 weeks (depending on study)
-Surgery and conservative treatment are similar, although surgery helps with pain relief sooner
Somatic referred pain is ________ but radicular pain is not
Common
With respect to clinical management, imaging is justified for the investigation of ________ and _________. The same cannot be said for __________
Radicular pain and radiculopathy; somatic referred pain
Nocioceptive back pain and somatic referred pain involved nerve injury (T/F)
False
Allodynia is not a typical feature of radicular pain or radiculopathy, unless there is true nerve damage and neuropathy rather than simply compression or inflammation.
True
A patient who is distressed by a pain shooting down the limb, cannot lie comfortably, and on examination has numbness or weakness in the leg
Radicular pain and radiculopathy
A patient with aching pain in the back, which spreads to the buttocks and thigh, but no lancinating pain and no neurological symptoms
Nocioceptive back pain and somatic referred pain
What is the role of the disc
Motion, force distribution, shock absorption
Why do disc injuries occur?
Underprepared for the load that is
placed on them.
- Tissues cannot withstand the
stress demands, causing them to
fail.
DDD
- Normal age-related change in the spine
- Discs lose water content as we age - Because of this, force is transmitted differently into tissues
- Failure occurs
- Discs become much more rigid as we age, which is why disc herniations are less common in people over the age of 60
Criteria of the presence of cervical radiculopathy
Positive upper limb tension test, involved-side cervical rotation ROM less than 60 degrees, positive distraction test, positive spurlings test A
