Head, Neck and Back Flashcards
What are the major red flags for back pain?
- back pain with hip or abdominal pain
- bowel/bladder changes
- previous history of cancer
- night pain
- no improvement after 4-6 weeks of PT
What is the key difference between mechanical and non-mechanical back pain?
Mechanical accounts for 97% of cases, while non-mechanical includes visceral causes (2%) and neoplasm/infection (1%).
What are the primary types of headaches?
Primary headaches include migraines and tension-type headaches.
What are secondary headaches?
Secondary headaches include cervicogenic and those caused by systemic conditions like cancer.
When should you refer a patient with headaches to a physician?
Refer if they have headaches with…
- waking at night
- personality changes
- vision changes
- seizures
- history of HTN/tumor
What are the systemic origins of headaches?
Systemic causes include seizures, personality changes, vision changes, worse in the morning, etc.
What are the mechanical causes of cervical spine pain?
- rheumatoid arthritis
- cervical myelopathy
What are the red flags for cervical myelopathy?
- (+) L’hermitte’s sign
- gait changes
- (+) Babinski
- Hoffmann’s test
What are the vasculogenic causes of cervical spine pain?
Cardiac and vascular issues.
How do you differentiate cervicogenic from systemic cervical pain?
Cervicogenic pain changes with activity and rest; systemic causes may not.
What are the systemic causes of thoracic spine pain?
Cardiac (MI, aneurysm)
GI (peptic ulcers).
What are the associated signs of systemic thoracic spine pain?
Constitutional symptoms like fever, pallor, high/low BP.
What are key questions for identifying inflammatory back pain?
Does pain alternate sides? Morning stiffness >30 mins? Does rest relieve pain?
What are the systemic causes of lumbosacral pain?
Inflammatory causes, systemic illness, and visceral pathology.
What are neurogenic causes of pain?
Radicular pain, sciatica, other neuropathies.
What are vasculogenic causes of pain?
AAA, vascular headaches, demand > supply issues.
What are the red flags for oncologic back pain?
History of cancer, age >50, unexplained weight loss, failure to improve after one month of treatment.
What are the clinical signs of oncologic back pain?
Pain with weight-bearing, midline tenderness, weakness, skin temperature differences.
What are the gynecologic causes of back pain?
Endometriosis, ovarian cysts, cyclic pain, fluctuating hormone levels.
What is the clinical presentation of endometriosis?
Back, pelvic, hip, or sacral pain, cyclic in nature, related to fluctuating hormone levels.
What are the risk factors for infectious causes of back pain?
Fever, immunosuppression, IV drug use, HIV.
What is vertebral osteomyelitis?
An infection of the vertebrae, often caused by MRSA, with risk factors including diabetes, IV drug use, or corticosteroids.
What are the signs and symptoms of cancer-related back pain?
Unexplained weight loss, history of cancer, constant/intense pain worse with WB, red flags for metastatic disease.
How do you differentiate cervicogenic from migraine headaches?
Cervicogenic: Pain varies with activity, neck stiffness. Migraine: Aura, photophobia, unilateral throbbing pain.
What are the signs of vascular vs neurogenic pain?
Vascular: Throbbing, worsens with activity. Neurogenic: Sharp, shooting, follows nerve root patterns.
What are the signs of psychogenic pain?
Cogwheel motion during muscle testing, amplified pain perception, reflexes inconsistent with complaints.
What are the signs of rheumatoid arthritis-related cervical spine pain?
AA subluxation, C2 nerve involvement, risk of myelopathy with long-standing RA.
What are viscerogenic causes of back pain?
GI (gallbladder, pancreas), renal (kidney stones), reproductive, pulmonary causes; shared innervation leads to referred pain.
What are the signs of peptic ulcer-related thoracic pain?
Referred pain to T6-T10, worse with NSAID use, symptoms affected by food intake.
What are the signs of gallbladder-related pain?
Referred pain at the 10th rib, onset after fatty meals, associated GI symptoms.
What are the signs of ovarian cysts?
Often asymptomatic until large, cyclical pain patterns, fluctuating with hormone levels.
What is the clinical presentation of vertebral osteomyelitis?
Gradual onset of severe pain over weeks, MRSA infection common, risk factors include diabetes, surgery, IV drug use.
