KCP: Back Pain Flashcards
Consequence of sitting to much
The psoas muscle can become shortenned leading to lordosis
Major causes of back pain
- Ankylosing spondylitis
- Mechanical back pain * Lumber radiculopathy -> osteoathritis * fractures
- Spinal chord compression * cauda equina syndrome
What is ankylosing spondylitis?
A long term condition where the spine becomes inflamed
Ankylosing spondylitis signs and symptoms
- 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
Ankylosing spondylitis treatments
- Exercise to reduce and manage pain
- Psysiotherepy
- NSAIDs
What is lumber radiculopathy
Inflamation of the nerve root in the lower back, typically involving the sciatic nerve
What causes lumber radiculopathy?
- Disk herniation
- Spondylosis (degenerated intervertebral disks) due to degenerative arthritis
Lumber radiculopathy sign and symptoms
Varies depending on the nerve root affected but generally pain, numbness and weakness affecting the lower limb
Lumber radiculopathy signs and symptoms L4
Motor weakness:
* Leg extension
Sensory loss:
* Medial knee
* Shin
Pain:
* Anterior thigh
Lumber radiculopathy signs and symptoms L5
Motor weakness:
* Toe extension
* Dorsiflexion
* Inversion and eversion
* Hip abduction
Sensory loss:
* Big toe
Pain:
* Posterior thigh
* Lateral leg
Lumber radiculopathy signs and symptoms S1
Motor weakness:
* Plantaflexion
* Achilles reflex loss
Sensory loss:
* Lateral foot
Pain:
* Posterior leg (calf)
Lumber radiculopathy treatment
- Exercise
- Cognitive behavioral therepy
- NSAIDs
- Avoid opioids (especially if chronic)
What are osteoporotic vertebral fractures
It is a compression fracture of the vertebral body
Causes of vertebral fractures
Can happen accutly with a fall or slowly overtime with osteoporosis
Signs and symptoms of vertebral fractures
- Sudden onset of back pain asscosiated with bending, lifting or coughing
- Pain resolves after 4-6 weeks
- Loss of height
- Possible kyphosis
Treatment of vertebral fractures
- Analgesia, paracetamol and short term opiates
- NSAIDs
- Osteoporosis diagnosis and treatments (vitamin d, calcium and bisphosphonates)
Cauda equina syndrome
Compression of the cauda equina
Cauda equina syndrome causes
- Protrusion of vertebral disk
- Cancer that spreads to the vertebra (tumor itself compresses it)
Cauda equina syndrome symptoms and signs
- Back pain
- Lower limb weakness
- Bowel and bladder dysfunction including urine retention
Why is cauda equina serious
- Could be cancer
- If it’s not fixed asap it might not recover
Cauda equina syndrome treatment
Possible surgical intervention
Back pain red flags
- 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)
What is “Bamboo Spine”?
Inflamation of the veterbral joints due to ankylosing spondylitis
Looks like bamboo on an X-Ray
