Common MSK problems spine (2) Flashcards
What ‘associated symptoms’ to ask abut in SOCRATES for back pain?
- sensory disturbance
- weakness
- urinary retention or incontinence
- fevers
- fatigue
- weight loss
- early morning stiffness
What to look for/at during inspection of the spine?
What to palpate during FEEL part of the spinal exam?
How to assess cervical spine movement?
How to assess lumbar and thoracic spine movement?
Special tests in spinal examination
What to do in terms of neuro examination in patient with back pain?
- Document sensation and power at each nerve root level
- PR examination (perianal sensation and anal tone)
How to test for L2?
L2: hip flexion
How to test for L3?
L3: knee extension
How to test for L4?
L4: ankle dorsiflexion
How to test for L5?
L5: big toe extension
How to test for S1?
S1: Ankle plantarflexion
Differential diagnosis of back pain
Ix for traumatic low energy spinal fractures
Low energy osteoporotic fracture
- Plain x-ray
- Bone health: calcium, vitamin D, PTH
- DEXA scan to diagnose osteoporosis
Ix for traumatic high energy fractures
High energy fracture
- Exclude other injury → X-ray or CT
- MRI → if concern about neurological injury or ligamentous injury
Ix for inflammatory back pain
- FBC
- ESR, CRP
- immunoglobulins
- RF
- HLA-B27
- Imaging - x-ray
Ix for infective back pain
- FBC
- ESR
- CRP
- blood cultures
- consider testing for TB
- Imaging: MRI
- Possible biopsy
Ix for back pain of suspected cancerous origin
Blood tests:
- PSA
- myeloma screen
Local staging: CT/MRI
Distant staging: CT chest/abdo/pelvis
- Bone scan
- Bone biopsy
- Critical to determine primary tumour from metastasis
What types of spinal problems need emergency specialist assessment?
Emergency specialist assessment
- Cauda equina syndrome
- Traumatic fracture
- Infection
Urgent specialist assessment
- Cancer
- red flag symptoms
Drug therapy for non-specific / simple back pain
- regular analgesia not p.r.n
- initial treatment is paracetamol and NSAIDs e.g. ibuprofen or diclofenac
- add codeine
- consider the short term use of a muscle relaxant e.g. baclofen or diazepam
Advice re activity levels in mechanical back pain
- Avoid bed rest
- Continue ADLs
- Increase their physical activities over a few days or weeks
- Stay at work or return to work as soon as possible
- Avoid mechanical stress eg. Lifting
