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