June4 M1-Mechanical Back Pain Flashcards
red flags and yellow flags in LBP (lower back pain) are used to tease out what things
- red flags = sinister signs of low back pain (grave spinal pathologies)
- yellow flags = patients who are at risk of developing chronic LBP and cost a lot of health care dollars
red flags in general in LBP + most important one
- night pain (doesn’t always mean something terrible is happening)
- fever
- weight loss
- prior history of cancer is the strongest predictor of a red flag, a bad pathology
acute LBP def
for <3 months
different categories of problems that can be the cause of acute LBP
- cauda equina
- tumour
- infection
- fracture (trauma)
- non-spinal pathologies (like appendicitis)
- inflammatory pathologies
- syndromes (lumbar (disk, facet, etc.), claudication or radicular)
red flag diseases in LBP (things you don’t want to miss). the grave spinal pathologies
- cauda equina syndrome
- fracture
- infection
- neoplasm
- grave non spinal pathologies
symptoms of cauda equina in acute LBP
back pain with
- bilateral leg pain
- bilateral leg weakness
- saddle (numbness in perianal area) anaesthesia
- fecal or urinary dysfunction
symptoms of fracture in acute LBP
back pain with
- localized pain
- well defined severe trauma
- minor trauma (osteoporosis, as simple as coughing)
- spondylolysis, spondylolisthesis (motion type of fracture with repetition)
symptoms of infection in acute LBP
back pain with
- fever, chills
- severe night time pain
- prior surgical intervention or spine injection
- recent bacterial infection
- IVDU
- immune suppressed
symptoms of neoplasm (tumor) in acute LBP
back pain with
- pt >50
- prior history of cancer
- fever
- chills
- weight loss
- severe night time pain
- pain at rest
grave non-spinal pathologies that are red flags you can’t miss in acute LBP
- perforated gastric or duodenal ulcer
- acute pancreatitis
- appendicitis (retrocecal)
- renal colic
- pyelonephritis
- ruptured ectopic pregnancy
- endometriosis
- dissecting abdominal aortic aneurysm (AAA)
symptoms of acute LBP because of a dissecting AAA
back pain with
- male >50
- PMHx of htn, vasculopathy, anti-coagulants
- abdominal pain
- shock
- syncope
how does management change for a patient with yellow flags (predisposition to become chronic LBP)
will treat more aggressively
yellow flags (predictors of chronicity) of chronic LBP in patients with no history of LBP
- psychologic state (kinesiophobia = fear of mvmt, catastrophization = think everything they have is bad, depression)
- intense pain
- radiation below the knee
- think they are in poor health, very disabled and don’t believe they’ll get better
- psychosocial factors (other things not going well in their life: stress, job, bad financial support, relationship, etc.)
yellow flags (predictors of chronicity) of chronic LBP in patients with a prior history of LBP (what yellow flags predict recurrence)
- prior episodes of LBP
- poor general health
- job insatisfaction
- professional status
- salary
- social contacts, sense of indemnification
LBP prevalence and important concept
- back damage: degenerative changes (disk, annulus, facet, central and lateral and compressing foraminal stenosis, etc.) is correlated with aging (50% of 50 yo have it. 85% of 80+ yo have it
- is part of normal aging, so is less a pathology than we might think
- DON’T HAVE TO OVERINVESTIGATE*
