CSI 13 Flashcards
Common causes of back pain (4)
pulled muscle (strain).
slipped disc
sciatica
ankylosing spondylitis
Medication for back apin
ibuprofen (NSAID) not paracetemol on its own
when to see a gp (4)
back pain does not improve after treating it at home for a few weeks
the pain is stopping you doing your day-to-day activities
the pain is severe or getting worse over time
you’re worried about the pain or you’re struggling to cope
10 red flags
a high temp
lump that has changed shape
lost weight
tingling around genitals/ both legs
loss of bowel/bladder control (peeing and pooping) NOT constipation)
chest pain
swelling in back
worse at night/cannot sleep
after a serious accident worse on sneezing, coughing
top of back between shoulders
lumbago meaning?
lower back pain
treatments for back pain prescribed by GP?(3)
painkillers (nsaids)
CBT
PT
3 common & 3 uncommon causes of lower back apin
- pulled muscle
- herniated disc
- compression fracture
- Malignancy
- Cauda equina
- osteomyelitis
vertebral causes of back pain
Compression fracture
spondylolysis
osteomyelitis
muscles causes of back pain
pulled muscle
spinal cord problems
compression
malignancy
nerve problems with back pain
CES
herniated nuclues
3 pathways of nuerones, what they do and if they switch
senation : dorsal column pathway (fine touch, proprioception, vibration) and spinothalamic pathway (pain, temp, crude touch)
Motor: corticospinal
spinothalamic pathway
left mechanorceeptor -> dorsal horn -> (reticular formen if dull pain) ->somatosensory cortex. sharp pain is faster
Somatotrophy
hemisphere of brain: lateral to medial.
(tongue most lateral)face,hand,arm, hip (most superior), leg, toe ,genital (most inside )
contralateral arrangement
DC: swaps in medulla, ipsilateral up SC the switch
ST: swaps in spinal cord, contralateral up SC switched already
convergence theory
visceral nuerones converge with somatic nureones. eg heart pain is felt in skin of chest
3 differentials in case
radiculopathy
CES
Mechanical back pain
mechanical back pain?
Caused by abnormal stress and strain on muscles of the vertebral column
Triggered by certain movements/ positions, comes and goes
Radiculopathy
A nerve root is pinched as it leaves, usually unilateral
CES
Lumbosacral nerve roots are severely compressed
Usually bilateral
differences between radiculopathy and CES?
CES usually L4-S2 while radiculopathy is higher up, this is usually because radiculopathy compression is on nerve roots (less protected -> lateral compression. medial compression doesnt do much because of disc vertebrae) medial/central compression in cauda quina causes Lower motor nuerone nueropathy usually by prolapsing disc
6 Symptoms of cauda equina
- bilateral sciatica
- sadle paraesthesia (genital, butt, inner thigh)
- difficulty initiating micturition (filled bladder)
- erectile dysfunction
- motor weakness (dorsiflexion, extension + elevation of knee joint)
- anal laxity
define sciatica and explain why bilateral sciatica comes about?
nerve pain in leg from compressed sciatic nerve
formed from L4 TO S3. disc herniation causes CES pulposus displaced. spinal nerves from both sides affected
what plexuses supply lower extremeties
umbar and sacral plexuses
nerve roots S234 (3P’s)
Poo/Pee/Penis (erection)
Sympathetic vs parasympathetic activations
parasym (S2-4) allows you to pee, sym **(L1-2) **doesnt. So when only sym is activated it causes urinary retention
where does CES occur?
L3-S2
Parsympathetic/ Sympathetic nervous system! What nerve comes out of sacral region parasym?
splanchnic
What investigations?
MRI spine + try to treat within 48 hours
At what vertebrae level does the spinal cord end?
L1
What are rare causes of CES?
INFECTION OR TUMOUR
when are a-delta fibres used as opposed to c fibres??
a delta - SHARP pain- FAST (myleinated)
c fibres - DULL pain- SLOW
parasym + sym jobs in micturition
- detrusor muscle contracts (p)
- internal urinary sphincter relaxes (p)
Criteria for a successful claim
- below a reasonable standard, caused a loss/damage “causation”.
dorsal column route
mechanoreceptor-> medulla -> thalamus-> top part of brain (somatotrophy)
most common places to get CES?
L4/L5 L5/S1
