Eval of Back Pain in PC Flashcards
When patients come in with LBP that cannot be attributed to a specific disease or spinal pathology, we should label it as what?
Non-specific lbp
What are major conditions that need to be ruled out for LBP?
- ankylosing spondylitis
- compression fracture
- symptomatic herniated disc
- spinal stenosis
- cancer
- cauda equina
- spinal infection
What is the timeframe considered for acute LBP?
< 4 wks
What is the timeframe considered for subacute LBP?
4-12 wks
What is the timeframe considered for chronic LBP?
> 12 wks (only 20% will move into chronic)
Name the red flags of back pain (TUNAFISH)
Trauma Unexplained weight loss Neurologic symptoms Age > 50 Fever IV Drug Use Steroid Use Hx of Cancer
T/F: a patient with a hx CA who presents with LBP is metastatic disease until proven otherwise
True
What are the mc cancer metastasis that spread to spine/bone?
breast, lung, prostate
What are these sxs of?
unexplained weight loss, pain >1 mo, failure to improve with conservative therapy, and night time pain
Fever + back pain = what?
spinal abscess until proven otherwise
(even if RF for spinal abscess but NO FEVER) = spinal abscess until proven otherwise
In a spinal infection, what is the most sensitive and specific lab choice?
ESR
In a spinal infection, what is the DOC?
MRI with and without
with con looks for abscess and without looks at the bone
In longterm steroid use, what should we be concerned about with patient?
compression fracture
If we are concerned for a compression fracture, what is the DOC?
plain films (tells you % of height loss)
These are signs of what disease?
- morining stiffness
- improvement with exercise
- onset of pain age <40
- pain progression, slow
- pain > 3 mo
ankylosing spondylitis
what is the cornerstone for ankylosing spondylitis?
reduced flexion AND HLAB-27
What is the DOC in ankylosing spondylitis?
- Pelvic xray (shows bilateral and symmetric sacrolitis)
- xray lumbar spine shows bony sclerosis and bamboo sign
How to dx a lumbar disc herniation?
-SLR (80% sensitive and 40% specific) and with the addition of the crossed straight leg raise it is 90% specific
The SLR will ilicit pain on the same/opposite side whereas CRSLR will ilicit pain on the same/opposite side?
SLR- same
CRSLR- opposite
What are two common findings found in patients with impaired ankle reflex + weak dorsiflexion?
surgical lumbar herniation
What is the TOC for lumbar disc herniarion and at how many weeks is it ordered?
MRI with and without contrast and >6 weeks
Spinal stenosis can sometimes prevent like PVD so it is important to check what?
pulses
An interesting finding in spinal stenosis is that pain is not provoked by what exercise?
bike riding
What is the TOC in spinal stenosis?
First do xray and if it shows degenerative changes then you should do MRI
Don’t forget to check ______ in patients with cauda equina
rectal tone (they will have decreased rectal tone)
What is the TOC for cauda equina?
emergent MRI and emergent neurosurg consult
T/F: no imaging or other diagnostic tests are needed initially in a patient with nonspecific low back pain
TRUE
If patients have no improvement in LBP in >6wks, what TOC?
MRI
Are any labs helpful in the eval of LBP?
**ESR, CBC, lactate, blood cultures
Plain film xray and ESR is sufficient workup in the majority of patients.
First line meds for LBP
Nsaid or APAP (neither is superior)
Second line for LBP
muscle relaxants but greatest benefits if startd in 1-2 wks of onset of LBP
When should you d/c muscle relaxants if they are not working?
within 2-4 wks
Third line tx of LBP
antidepressants (SNRI)
Are corticosteroids generally recommended for LBP?
No
What is a good f/u for patients with LBP?
4 wks sooner if pain progresses
