LG4.11 Regional Back Pain Scheme Presentation – Dr. Kirsch Flashcards
Red flags of infection?
ii. ReNight sweat/pain
iii. Unexplained weight loss
iv. Recent bacterial infection
v. Pain despite rest and analgesics
vi. IV drug users, immunocompromised
b. Sialorrhea: excesive saliva production
Red flags of Neurologic Etiologies Cervical?
i. Hx Red Flag
1. Major Trauma
2. Minor Trauma in elderly
ii. Physical Red Flag
1. Bowel or bladder incontinence (acute)
2. Saddle anesthesia (perianal/perineal)
3. Decreased/absent anal sphincter tone
Cause/symptoms of Occipto-alanto dislocation?
i. Hyperextension/hyperflexion or lateral hyper
ii. Apena/loss of motor control
Cause/symptoms of Herniated crevical disc?
i. Younger patient with abnormal upper extremity neurologic examination
ii. Cervical radiculopathy
iii. Pain in arm
What is Radiculopathy?
i. Radiculopathy: Nerve root compression at the neck with resultant pain, tingling and numbness, with or without loss of function in the area supplied by the affected nerve.
What are common causes of cervical radiculopathy and stenosis?
- Neural foraminal narrowing, from cervical arthritis in older adults
- Cervical disk lesion (Disk degeneration or disk degeneration or disk herniation)
- Most common location C5-C6 or C6-C7
What is viscera somatic reflex?
Referred pain
What is the history of vertebral artery insufficiency?
- Headache (occipital
- Pulsatile tinnitus
- Cranial nerve palsies
What are common symptoms of Acute cervical strain/sprain?
- Dysphonia
- Dysphagia
What are general characteristics of chronic neck/cervical spondylosis?
a. Limited motion or motion or morning stiffness
b. Older patient with limited motion, pain on extension
c. Paraspinal tenderness
d. Electric shocks with cervical flexion
What is the mod common spinal cord disorder from spondylosis?
Cervical spondylotic myelopathy
What are the general characteristics of Osteomyelitis?
a. Bone infection that can lead to destruction of tissue
i. Chronic, slow progression, dormant phase, can last years
ii. Restricted motion
iii. Tenderness, hyperemia and swelling over area
What are the general characteristics of thoracic pain with abdominal disease?
a. Tumors of stomach or duodeneum
b. Biliary disease
c. Pancreatic disease
d. Pyelonephritis
What are the general characteristics of thoracic Aortic aneurism rupture?
- Pain is prior to rupture
- Acute pain
- Hypotension
- Bedside echocardiogram
What are the general characteristics of Thoracic region somatic dysfunction?
- Pain better with rest, worse with activity
- Traumatic history
- TART
What are the general characteristic of Thoracic strain?
a. Mechanical induced muscle spasm
i. History
1. Paravertebral discomfort relieved by rest, worsened by activity
2. Lifiting heavy object, fall, or car accident
ii. Physical
1. Tenderness in back, restricted and painful ROM, Normal reflexes and strength, holds unusal posture
What are the general characteristics of congenital scoliosis?
a. Lateral curves in the thoracic region
b. Usually a rotatory component as well
c. Idiopathic common
What are red flags of cancer?
a. History of Cancer
b. Unexplained weight loss
c. Over 50 y/o or 17 y/o
d. Night pain or pain with rest
e. Pain persists for more than 4 to 6 weeks
What are general characteristics of Cauda Equina Syndrome?
a. Urinary incontinence or retention
b. Saddle anesthesia
c. Anal sphincter tone decreased or fecal incontinence
d. Bilateral lower extremity weakness or numbness
What are the general characteristics of herniated nucleus pulpous?
a. Severe muscle weakness
b. Foot drop
What are general characteristics of Abdominal Aortic Aneurysm?
a. Abdominal pulsating mass
b. Atherosclerotic vascular disease
c. Pain at rest of nocturnal pain
d. Age greater than 60 years
e. Can mimic groin pain
What are general characteristics of Diskitis?
a. Infection of intervertebral disc
b. Can lead to destruction of the disc
c. Fever, chills, and sweats
d. Night pain that interrupts
What are general characteristics of a thoracic herniated disc?
a. Younger patient abnormal lower extremity neurologic examination
b. Unilarteral leg pain
c. Pain worse with sitting
d. Postivie straight leg raise test
What are general characteristics of ruptured abdominal aortic aneurysm?
a. Hx
i. Chest, low back, or groin pain
ii. Pain**
b. Physical
i. Palpable, pulsatile mass
ii. Acute pain and hypotension
What are general characteristics of degenerative disc is ease and nerve root compression?
a. Limited motion and stiffness
b. Pain radiates to one or both buttocks
c. Pain worse by activity
d. Lisiting due to muscles spasms
What are general characteristics of Ankylosing spondylitis?
a. Chronic inflammatory disease
b. Strong genetic predipostion
c. Mainly affects joints in the spin and SI joint
What are general characteristics of spondyloisthesis?
a. Pain aggravated by bending, lifting, twisting.
b. Radiculopathy possible
c. Fatigue
