DSA Low Back Pain Flashcards
Acute low back pain
<12 weeks
high likelihood to resolve (no residual loss of fxn)
simple or no management required
Chronic low back pain
> 12 weeks
high risk for loss of fxn/disability
tx resistant (need many different types of management)
Risk factors for low back pain
lifting weight @ work smoking depression obesity inactivity
What risk factors increase perception of pain?
smoking & depression
Protective factors for low back pain
regular exercise (exercise is MOST important factor)
education + exercise (education is not effective alone)
What are the common etiologies of low back pain?
Mechanical (97% of all causes)
Visceral Disease
Non-mechanical
Describe visceral etiologies for low back pain
likely present as acute low back pain w/ other sxs
often is referred pain from abdominopelvic structures (GI organs, abdominal aorta, renal, GU organs, endometriosis)
Describe non-visceral etiologies for low back pain
neoplasms (wt loss, deep bone pain @ night)
infection (fever, chills)
inflammatory (ankylosing spondylitis, psoriatic arthritis)
What genotype is associated with low back pain due to inflammation?
HLA B27
What are the major mechanical MSK etiologies of low back pain?
sprain/strain/overuse syndrome
piriformis syndrome
psoas syndrome
short leg syndrome
Etiology of Sprain/Strain/Overuse syndrome
injury & stress on soft tissue structures (either injury to muscles or injury to ligaments)
Pain pattern & DX of sprain/strain/overuse syndrome
aching pain over injured structure
DX by PE & palpation, by exclusion
Etiology of Piriformis syndrome
hypertonicity of piriformic muscle, nerve entrapment of sciatic nerve (as exits btwn priformis & superior gemelllus muscles)
Pain pattern & DX of piriformis syndrome
worse w/ sitting & @ risk if have trauma or overuse
DX w/ PE & + FAIR test (reproduces pain w/ Lat recumb, flex, IR & AB)
Etiology of psoas syndrome
chronic hypertonicity of psoas muscle (from T12-L4 to greater trochanter)
Pain pattern & DX of psoas syndrome
pts will hunch/flex lumbar spine & have pain originating @ thoracolumbar junction or as hip pain
pain will worsen w/ lumbar extension & standing straight up
DX by palpation of muscle, + Thomas test, Pelvic side shift will resolve w/ manipulation
Etiology of pelvic side shift
innominate is shifted to R or L of midline
DX of pelvic side shift
laterally translate innominate to test for preference during postural exam
+R pelvic side shift (pelvis translates to R but resists motion to L)
Etiology of short leg syndrome
anatomic leg length discrepancy creates sacral base unleveling leading to MSK stress imbalance
Pain pattern & DX of short leg syndrome
presents similar to overuse syndrome (pain in affected structures above low back)
common w/ scoliosis & will worsen w/ activity or walking
DX by PE (pelvic side shirt will NOT resolve & translates away from short leg), postural Xray
How do you tx short leg syndrome?
tx ONLY is leg length discrepancy if >5mm or >1/5 inch
add 1/8 (flexible) or 1/16 (fragile) inch every 2 weeks
**if acute change in leg length, replace full discrepancy immediately
Etiology, pain pattern & DX of degenerative disc dz
degeneration leads to stress & inflammation of nociceptors (in annulus fibrosis)
non-specific pain pattern, risk w/ age & inactivity, will worsen w/ bending forward or sneeze/cough
DX w/ Xray
Etiology, pain pattern & DX of spondylolysis
defect/stress fracture of pars interarticularis
usually asymptomatic w/ any pain usually over L5, risk if young athlete & worsens w/ hyperextension
DX w/ X ray demonstrating Scotty dog sign
Etiology, pain pattern & DX of spondylolisthesis
anterior displacement of vertebrae secondary to bilateral pars defects
non specific pain pattern (usually @ L4/L5), risk w/ age or if have bilateral spondylolysis, worsens w/ extension & activity
DX w/ palpable “step off” on PE, can see on X ray
