KCP: Back Pain

Question 1

Consequence of sitting to much

Answer 1

The psoas muscle can become shortenned leading to lordosis

Question 2

Major causes of back pain

Answer 2

• Ankylosing spondylitis
• Mechanical back pain * Lumber radiculopathy -> osteoathritis * fractures
• Spinal chord compression * cauda equina syndrome

Question 3

What is ankylosing spondylitis?

Answer 3

A long term condition where the spine becomes inflamed

Question 4

Ankylosing spondylitis signs and symptoms

Answer 4

• Pain - predominantly in the back but can also be in the buttocks and hip joints
• “Bamboo spine” on X-Ray due to inflamation of the joints
• Insidious onset
• The pain improves with exercise and worsens with rest - bad at night
• Affects young people - symptoms first show before 45.
• There is a link between this and the gene varient HLA-B27

Question 5

Ankylosing spondylitis treatments

Answer 5

• Exercise to reduce and manage pain
• Psysiotherepy
• NSAIDs

Question 6

What is lumber radiculopathy

Answer 6

Inflamation of the nerve root in the lower back, typically involving the sciatic nerve

Question 7

What causes lumber radiculopathy?

Answer 7

• Disk herniation
• Spondylosis (degenerated intervertebral disks) due to degenerative arthritis

Question 8

Lumber radiculopathy sign and symptoms

Answer 8

Varies depending on the nerve root affected but generally pain, numbness and weakness affecting the lower limb

Question 9

Lumber radiculopathy signs and symptoms L4

Answer 9

Motor weakness:
* Leg extension

Sensory loss:
* Medial knee
* Shin

Pain:
* Anterior thigh

Question 10

Lumber radiculopathy signs and symptoms L5

Answer 10

Motor weakness:
* Toe extension
* Dorsiflexion
* Inversion and eversion
* Hip abduction

Sensory loss:
* Big toe

Pain:
* Posterior thigh
* Lateral leg

Question 11

Lumber radiculopathy signs and symptoms S1

Answer 11

Motor weakness:
* Plantaflexion
* Achilles reflex loss

Sensory loss:
* Lateral foot

Pain:
* Posterior leg (calf)

Question 12

Lumber radiculopathy treatment

Answer 12

• Exercise
• Cognitive behavioral therepy
• NSAIDs
• Avoid opioids (especially if chronic)

Question 13

What are osteoporotic vertebral fractures

Answer 13

It is a compression fracture of the vertebral body

Question 14

Causes of vertebral fractures

Answer 14

Can happen accutly with a fall or slowly overtime with osteoporosis

Question 15

Signs and symptoms of vertebral fractures

Answer 15

• Sudden onset of back pain asscosiated with bending, lifting or coughing
• Pain resolves after 4-6 weeks
• Loss of height
• Possible kyphosis

Question 16

Treatment of vertebral fractures

Answer 16

• Analgesia, paracetamol and short term opiates
• NSAIDs
• Osteoporosis diagnosis and treatments (vitamin d, calcium and bisphosphonates)

Question 17

Cauda equina syndrome

Answer 17

Compression of the cauda equina

Question 18

Cauda equina syndrome causes

Answer 18

• Protrusion of vertebral disk
• Cancer that spreads to the vertebra (tumor itself compresses it)

Question 19

Cauda equina syndrome symptoms and signs

Answer 19

• Back pain
• Lower limb weakness
• Bowel and bladder dysfunction including urine retention

Question 20

Why is cauda equina serious

Answer 20

• Could be cancer
• If it’s not fixed asap it might not recover

Question 21

Cauda equina syndrome treatment

Answer 21

Possible surgical intervention

Question 22

Back pain red flags

Answer 22

• Progressive or severe motor deficit
• Suspected or known cancer (metastases)
• Fever (infection)
• Urinary retention, urinary or faecal incontinence
• Numbness around the anus
• Bilateral symptoms (entire spinal cord could be compressed)

Question 23

What is “Bamboo Spine”?

Answer 23

Inflamation of the veterbral joints due to ankylosing spondylitis

Looks like bamboo on an X-Ray