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control > L12 - back pain > Flashcards

L12 - back pain Flashcards

1
Q

function of the spine

A
  • allows for a full range of movement
  • protects spinal nerves
  • acts as a shock absorber
  • flexibility
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2
Q

curves in normal health spine (descending)

A
  • cervical lordosis
  • thoracic kyphosis
  • lumbar lordosis
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3
Q

components of intervertebral discs

A

anulus fibrosis

nucleus pulposus

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4
Q

anulus fibrosis

A

touch, fibrous

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5
Q

nucleus pulposus

A

squidgy

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6
Q

trapped nerve

A

nucleus pulposus herniates

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7
Q

why does back become stiff with age

A
  • discs lose water
  • lose strength
  • become thin
  • tears due to repetitive loading
  • weaker discs = slacker ligaments
  • spine is less stable
  • spine grows osteophytes
  • increased load over facet joints
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8
Q

how does back pain result in muscle weakness and wasting

A

people are afraid to move because it hurts

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9
Q

key messages regarding a healthy back

A

keep flexible

keep strong

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10
Q

determinants of back pain

A
  • genetics
  • environment
  • body weight
  • muscle strength
  • mechanical loading
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11
Q

risk factors for LBP at work

A
  • Heavy physical jobs
  • Lifting
  • Driving to work
  • Previous episodes of LBP
  • Mental health
  • Posture
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12
Q

LBP classification

A
  • simple backache
  • nerve route involvement
  • possible serious spinal pathology
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13
Q

simple mechanical back pain history

A
  • First episode often sudden onset while lifting/twisting/turning
  • Recurrent episodes with decreasing inter-episode frequency
  • Variable pain related to position/posture
  • Better lying flat
  • May radiate to buttock and leg
  • Often worse at the end of the day and better with lying down/resting
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14
Q

what % of people over 65 show wear and tear / degenerative changes to their spine

A

100

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15
Q

examples of degenerative changes to spine with age

A
  • facet arthritis
  • disc narrowing
  • osteophytes
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16
Q

early management of LBP

A
  • Simple analgesics
  • Physiotherapy
  • Rest for no longer than 1-3 days
  • Psychosocial management
  • Work absence only if unavoidable
  • Early return to work, possibly graded
17
Q

when to consider secondary care for LBP

A

if >6 weeks

18
Q

drug treatment for LBP

A
  • paracetamol
  • NSAIDs
  • opiods
  • anti-depressants
  • nerve modulators
19
Q

examples of opioids used for LBP

A

cocodamol
tramadol
morphine

20
Q

examples of anti-depressants used for nerve pain

A

amitriptyline, duloxetine

21
Q

examples of nerve modulators for LBP

A

gabapentin

pregabalin

22
Q

sciatica

A

slipped disc at point of sciatic nerve

23
Q

symptoms of sciatica

A
  • pins and needles in leg
  • numbness and weakness
  • loss of ankle jerk
  • foot drop
24
Q

rheumatology back pain diagnoses

A
  • Degenerative disease
  • Axial Spondyloarthritis
  • Osteoporosis
  • Osteomalacia
  • Paget’s disease
  • Infection
  • Tumour
25
Q

red flag symptoms for back pain

A
  • age at first onset
  • history of carcinoma
  • weight loss
  • constant pain >1 month
  • no response to treatment
  • pain worse at rest
  • history of IV drug abuse of HIV positivity
  • infections
26
Q

discitis

A

infection of spinal discs

27
Q

which cancers metastasis to bone

A 
breast
lung
prostate
thyroid
kidney
28
Q

inflammatory back pain

A
  • Insidious onset
  • Nocturnal pain with marked early morning stiffness
  • Better with exercise
  • Worse with rest
  • Family history
  • Buttock pain
29
Q

axial spondyloarthritis

A

inflammatory arthritis where main symptom is back pain

  • affects younger people
  • can result in spinal fusion
30
Q

osteoporosis risk factors

A
  • Age
  • Female
  • Smoking
  • Steroids
  • Alcohol
  • Family history
  • Inflammatory conditions
31
Q

why is osteoporosis named the silent disease?

A

does not give you pain until you fracture

32
Q

which area is most commonly affected by osteoporosis

A

lumbar spine

33
Q

why are females more susceptible to osteoporosis

A

loss of oestrogen after the menopause

34
Q

How is osteoarthritis prevented

A

HRT

35
Q

Paget’s disease

A

abnormally shaped, brittle bones

- raised alkaline phosphatase

36
Q

cauda equina syndrome symptoms

A
  • difficulty with micturition (urinating)
  • loss of anal sphincter tone / facet incontinence
  • saddle anaesthesia
  • LBP / leg pain
  • degenerative arthritis
37
Q

consequences of not treating caudal equine syndrome

A
  • permanent lower limb paralysis

- sexual, bladder and bowel dysfunction

38
Q

role of surgery in back pain

A
  • Cauda equina syndrome
  • Spinal stenosis
  • (sciatica)
  • Tumour/infection
  • Instability
39
Q

neoplastic / Infection history

A
  • Insidious onset, sometimes subacute
  • Slow deterioration
  • 24 hr pain
  • Weight loss
  • Associated symptoms
  • Sometimes fever (only sometimes though)

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