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Y4 Lecture Day II > Common MSK problems spine (2) > Flashcards

Common MSK problems spine (2) Flashcards

1
Q

What ‘associated symptoms’ to ask abut in SOCRATES for back pain?

A
  • sensory disturbance
  • weakness
  • urinary retention or incontinence
  • fevers
  • fatigue
  • weight loss
  • early morning stiffness
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2
Q

What to look for/at during inspection of the spine?

A
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3
Q

What to palpate during FEEL part of the spinal exam?

A
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4
Q

How to assess cervical spine movement?

A
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5
Q

How to assess lumbar and thoracic spine movement?

A
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6
Q

Special tests in spinal examination

A
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7
Q

What to do in terms of neuro examination in patient with back pain?

A
  • Document sensation and power at each nerve root level
  • PR examination (perianal sensation and anal tone)
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8
Q

How to test for L2?

A

L2: hip flexion

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9
Q

How to test for L3?

A

L3: knee extension

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10
Q

How to test for L4?

A

L4: ankle dorsiflexion

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11
Q

How to test for L5?

A

L5: big toe extension

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12
Q

How to test for S1?

A

S1: Ankle plantarflexion

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13
Q

Differential diagnosis of back pain

A
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14
Q

Ix for traumatic low energy spinal fractures

A

Low energy osteoporotic fracture

  • Plain x-ray
  • Bone health: calcium, vitamin D, PTH
  • DEXA scan to diagnose osteoporosis
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15
Q

Ix for traumatic high energy fractures

A

High energy fracture

  • Exclude other injury → X-ray or CT
  • MRI → if concern about neurological injury or ligamentous injury
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16
Q

Ix for inflammatory back pain

A
  • FBC
  • ESR, CRP
  • immunoglobulins
  • RF
  • HLA-B27
  • Imaging - x-ray
17
Q

Ix for infective back pain

A
  • FBC
  • ESR
  • CRP
  • blood cultures
  • consider testing for TB
  • Imaging: MRI
  • Possible biopsy
18
Q

Ix for back pain of suspected cancerous origin

A

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
19
Q

What types of spinal problems need emergency specialist assessment?

A

Emergency specialist assessment

  • Cauda equina syndrome
  • Traumatic fracture
  • Infection

Urgent specialist assessment

  • Cancer
  • red flag symptoms
20
Q

Drug therapy for non-specific / simple back pain

A
  • 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
21
Q

Advice re activity levels in mechanical back pain

A
  • 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

Y4 Lecture Day II (12 decks)

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