FN: Back Pain Flashcards
Red Flags
- Age 55 yrs
- Neurological disturbance (inc. sciatica)
- Spincter disturbance
- Bilateral or alternating leg pain
- Current or recent infection
- Fever, wt. loss, night sweats
- History of malignancy
- Thoracic back pain
- Morning stiffness
- Acute onset in elderly people
- Constant or progressive pain
- Nocturnal Pain
Cause of back pain
Mechanical Degenerative Inflammatory Neoplasm Infection
Mechanical causes
Strain/idiopathic Trauma Pregnancy Disc polapse Spondylolisthesis
Degenerative causes
Spondylosis
Vertebral collapse
Stenosis
Inflammatory
Ank SPond
Pagets
Neoplasm
Mets, myeloma Thyroid Bronchus Breast Kidney Prostate
Infection
TB
Abcess
L2 lesions causes weakness where
Hip flexion and adduction
L3 lesions causes
weakness in knee extension and hip adduction
Reflex - knee jerk
L4 lesions
Foot inversion and dorsiflexion
Knee extension
Knee jerk reflex
L5 lesion
Great toe dorsiflexion
Foot inversion and dorsiflexion
Knee flexion
Hip extension and abduction
Si lesion
Foot eversion
Foot and toe plantar flexion
Knee flexion
ankle jerk
Investigations
Usually only neccessary if red flags present
FBC, ESR, CRP, ALP, se electrophoresis, PSA
MRI
Management
Neurosurgical referral if neurology needed
Conservative
Medical
Surgical
Conservative
Max 2 day bed rest
Education- Keep active, how to lift/stoop
Physio
Pyschosocial issue re. chronic pain and disability
Warmth
