Final Scraps for Exam 1 Flashcards
Current recommendations suggest clinicians conduct a focused hx and physical exam to classify pts into 1 of 3 categories:
Diagnostic triage!
- Non-specific LBP
- LBP with potential radiculopathy or spinal stenosis
- LBP potentially due to serious spinal pathology (i.e. Tumor, infection, AS)
What are the things you’d want to rule out for serious spinal pathology?
- Cancer
- Spinal fx
- Infection
- Abdominal aortic aneurysm
- Kidney or urinary disorders
- Cauda equina
- Vascular claudication
- Ankylosing spondylitis
Absence of these 4 essentially rules out cancer
- Previous hx of non-skin cancer
- Failure of conservative tx in last month
- Age over 50
- Significant unexplained WL in the past 6 months
These lab values might indicate high likelihood of cancer
- ESR
- hematocrit under 30%
- anemia
- WBC over 12000
What are 5 characteristics that make spinal fx more likely?
- age over 50
- female
- major trauma
- pain and tenderness
- a distracting painful injury
What is the cause of spinal fx in gymnasts typically?
Microfracture
Corticosteroid use and spinal fx
- decreased bone density
- increased risk for OP related fx
In the absence of major trauma, vertebral fx present so similarly to these that only 30% are identified in clinical practice
Acute nonspecific LBP
Infection: Does lack of fever rule this out?
No: lack of fever does not significantly decrease the odds of infection
Risk factors for AAA
- family hx
- heart stuff
- cerebrovascular disease
- increased height
Decreased risk for AAA
- female
- DM
- African American
Presentation of AAA
- highly variable
- 75% are asymptomatic
- may report low t-spine, lumbar, abdominal, hip, or buttock pain
- not usu a cause of LBP
What would clue you in to kidney or urinary issues as a source of LBP?
- unilateral flank pain
- low ab pain above pubic bone
- may have pain radiating to groin
- difficuly initiating urination (or pain)
- blood in urine
- UTI hx
CES onset
- sudden OR
- progress quickly over a few hours or 1-2 days
Requires surgery within 48 hours
Most common cause of CES
- Large, midline posterior disc herniation, commonly at L4-5 or L5/S1
Other causes of CES
- spinal stenosis
- spinal tumor
- infection
- fx
S/s of CES
- changes in b/b
- saddle paresthesia/anesthesia
- unilateral or bilateral sciatica
- hard neuro signs (most common over butt, post/sup thighs, perineal)
- abn passive SLR
Vascular claudication is usually a symptom of:
PVD
Vascular claudication is caused by:
Insufficient blood flow to the LE
Vascular claudication can mimic
Neurogenic claudication
When do sx increase with vascular claudication?
- same distance each time
- walking uphill or up stairs
What decreases sx of neurogenic claudication?
- walking uphill
- sitting
- flexed spinal position
What things may make you suspect PVD?
- cool skin
- presence of at least one bruit
- palpable pulse abnormality
With AS, when does back pain improve?
Improves with exercise, but not with rest
What are some other key features of AS aside form improving with exercise?
- alternating buttock pain
- morning stiffness
- waking up during the last half of the night
What is the definition of radiculopathy?
s/s associated with nerve root pathology including
- paresthesia
- hypoesthesia
- anesthesia
- motor loss
- pain
What is the definition of symptomatic spinal stenosis?
- Narrowing of the spinal canal or lateral recess
- usually result of degenerative, developmental, or congenital disorders
This outcome measure is really only appropriate for pts with acute LBP who have had it less than 30 days
RMDQ
RMDQ
Roland Morris Disability Questionnaire
PSFS
Patient Specific Functional Scale
What age group are you most likely to see LBP?
30-60
Occupations most likely to be associated with LBP
- sales
- clerical work
- repair
- transportation
What are the physical stresses most commonly associated with back pain? (4)
- Heavy or frequent lifting
- Whole body vibration (driving)
- Prolonged or frequent bending or twisting
- Postural stresses (high spinal loads or awkward postures)
Which areas need to be cleared with LBP pts?
- lower t-spine and lumbosacral spine
- bilateral butt/LE (circumferentially)
- abdomen/groin
- N/T anywhere
When should you start looking for red flags?
When the pt reports worsening of sx
Morning stiffness: When would you think MSK?
Better in the morning
Eased by rest
Morning stiffness: When would you think DJD?
- better or less painful in morning
- eased with movement within 30-60 mins
Morning stiffness: When would you think systemic inflammatory?
- better with rest, but present with greatest stiffness in morning
- usu longer than 60 mins
Morning stiffness: When would you think non-MSK?
Sx unchanged in morning
Common side effects for LBP meds: NSAIDs
back and/or shoulder pain for
- retroperitoneal bleeding
- GI sx
- kidney/liver problems
- MI
Common side effects for LBP meds: corticosteroids
- AVN femoral head
- OP
- immunosuppression
- steroid-induced myopathy
Common side effects for LBP meds: antidepressants
Movement disorders
Common side effects for LBP meds: skeletal muscle relaxants
Sedation
Common side effects for LBP meds: statin-related drugs
MSK pain
Common side effects for LBP meds: opioids
- nausea
- constipation
- dry mouth
- dizziness
- addiction
What is the strongest predictor of future LBP?
Presence of leg pain
Failure to centralize sx is considered a strong predictor for
Chronicity
