Common orthorpaedic/gynaecological history - Lower back pain Flashcards
What would you ask about lower bac pain?
- SOCRATES
- Assocaitions - sciatica, stiffness/deformity, incontinence, neurological symptoms
- Reg Flags
What conditions would you want to check for in a low back pain history?
- Cauda equina
- Infection/cancer
- Fracture
- Spondyloarthropathy
What features assocaited with back pain would you want to check for when thinking about cauda equina as a cause?
- Urinary incontinence/retention
- Contipation/faecal incontinence
- Bilateral leg pain
- WEakness
- Saddle anaesthesia
- Sexual dysfunction
What features associated with back pain would you want to ask about when checking for red flag features of malignancy/infection?
- Age < 20/>55 at onset
- Cancer history
- Night pain
- Weight loss
- Fever
- Injecting drugs
- Immunosuppression
What red flag features associated with low back pain would you check for when checking for fracture as a cause?
- Trauma
- Severe central spinal pain
What red flag features assocaited with low back pain would you want to check for when checking for spondyloarthropathy?
- Early morning stiffness
- Worse with rest
What would you want to ask about on systemic enquiry in someone with low back pain?
- Fever, night sweats, weight loss
- Neuro - weakness, paraesthesiae, muscle wasting, pain numbness
What features of low back pain suggest a muscular cause?
- Acute onset
- Paraspinal muscles affects, not central
What features of low back pain suggest lumbar sponlylosis/facet joint problems as a ccause?
- Chronic episode mechanical back pain
- Backache related to standing/walking a lot/sitting in one place
- Progressive stiffening
What features assocaited with low back pain would suggest lumbar disc prolapse as a cause?
- Acute onset while lifting/bending/sneezing/coughing
- Severe pain
- SCiatica, leg pain often worse than back pain
- Neurological symtpoms - weakness, numbness - L4/5/S1 distribution
What features of low back pain would suggest discitis as a cause?
- Fever
- Systemic upset
- Risk factors - injecting drug user
What features of low back pain would suggest spinal fracture as a cause?
- History of trauma
- Sudden onset
What features of low back pain suggest ankylosing spondylitis as a cause?
- Morning stiffness > 30 minutes
- Pain worse on rest
What are orthopaedic causes of back pain?
- Muscular
- Lumbar spondylosis and facet joint syndrome
- Lumbar disc prolapse
- Discitis
- Cauda equina syndrome
- Ankylosing spondylitis
- Paget’s disease
- Spondylolisthesis
- Osteoporotic bone fracture
What are haematological causes of back pain?
Myeloma
What are non-orthopaedic/rheumatological causes of low back pain?
- Pyelonephritis
- PID
- Pancreatitis
- AAA
What rheumatological conditions would you consider as a cause of lower back pain?
Ankylosing spondylitis
What features of low back pain would suggest Spinal tumour as a cause of back pain?
- Pain over months
- Progressive pain/paresis in one or both legs
- Focal neuro signs - depending on location
What features assocaited with low back pain would suggest spinal TB with abscess/psoas abscess?
- Pain onset over weeks/months
- Low-grade fever, tenderness
- Increased WCC/ESR
- Background debilitation/diabetes/IVDU
What features on examination would suggest posterolateral disc herniation as a cause of low back pain?
- Back flexed and extension restricted
- Straight leg raise stopped at 45o
- Loss of sensation in lateral foot (L4/L5)
- Loss of ankle jerk and sensation in sole of foot (S1)
What are features of low back pain on examination suggest anterior disc prolapse?
- Flaccid paresis of leg/s
- Loss of knee/ankle jerk
- Extensor plantar
- Loss of vibration sense, touch and pain with sensory
