LG4.11 Regional Back Pain Scheme Presentation – Dr. Kirsch

Question 1

Red flags of infection?

Answer 1

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

Question 2

Red flags of Neurologic Etiologies Cervical?

Answer 2

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

Question 3

Cause/symptoms of Occipto-alanto dislocation?

Answer 3

i. Hyperextension/hyperflexion or lateral hyper

ii. Apena/loss of motor control

Question 4

Cause/symptoms of Herniated crevical disc?

Answer 4

i. Younger patient with abnormal upper extremity neurologic examination
ii. Cervical radiculopathy
iii. Pain in arm

Question 5

What is Radiculopathy?

Answer 5

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.

Question 6

What are common causes of cervical radiculopathy and stenosis?

Answer 6

1. Neural foraminal narrowing, from cervical arthritis in older adults
2. Cervical disk lesion (Disk degeneration or disk degeneration or disk herniation)
3. Most common location C5-C6 or C6-C7

Question 7

What is viscera somatic reflex?

Answer 7

Referred pain

Question 8

What is the history of vertebral artery insufficiency?

Answer 8

• Headache (occipital
• Pulsatile tinnitus
• Cranial nerve palsies

Question 9

What are common symptoms of Acute cervical strain/sprain?

Answer 9

• Dysphonia

- Dysphagia

Question 10

What are general characteristics of chronic neck/cervical spondylosis?

Answer 10

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

Question 11

What is the mod common spinal cord disorder from spondylosis?

Answer 11

Cervical spondylotic myelopathy

Question 12

What are the general characteristics of Osteomyelitis?

Answer 12

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

Question 13

What are the general characteristics of thoracic pain with abdominal disease?

Answer 13

a. Tumors of stomach or duodeneum
b. Biliary disease
c. Pancreatic disease
d. Pyelonephritis

Question 14

What are the general characteristics of thoracic Aortic aneurism rupture?

Answer 14

• Pain is prior to rupture
• Acute pain
• Hypotension
• Bedside echocardiogram

Question 15

What are the general characteristics of Thoracic region somatic dysfunction?

Answer 15

• Pain better with rest, worse with activity
• Traumatic history
• TART

Question 16

What are the general characteristic of Thoracic strain?

Answer 16

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

Question 17

What are the general characteristics of congenital scoliosis?

Answer 17

a. Lateral curves in the thoracic region
b. Usually a rotatory component as well
c. Idiopathic common

Question 18

What are red flags of cancer?

Answer 18

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

Question 19

What are general characteristics of Cauda Equina Syndrome?

Answer 19

a. Urinary incontinence or retention
b. Saddle anesthesia
c. Anal sphincter tone decreased or fecal incontinence
d. Bilateral lower extremity weakness or numbness

Question 20

What are the general characteristics of herniated nucleus pulpous?

Answer 20

a. Severe muscle weakness

b. Foot drop

Question 21

What are general characteristics of Abdominal Aortic Aneurysm?

Answer 21

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

Question 22

What are general characteristics of Diskitis?

Answer 22

a. Infection of intervertebral disc
b. Can lead to destruction of the disc
c. Fever, chills, and sweats
d. Night pain that interrupts

Question 23

What are general characteristics of a thoracic herniated disc?

Answer 23

a. Younger patient abnormal lower extremity neurologic examination
b. Unilarteral leg pain
c. Pain worse with sitting
d. Postivie straight leg raise test

Question 24

What are general characteristics of ruptured abdominal aortic aneurysm?

Answer 24

a. Hx
i. Chest, low back, or groin pain
ii. Pain**
b. Physical
i. Palpable, pulsatile mass
ii. Acute pain and hypotension

Question 25

What are general characteristics of degenerative disc is ease and nerve root compression?

Answer 25

a. Limited motion and stiffness
b. Pain radiates to one or both buttocks
c. Pain worse by activity
d. Lisiting due to muscles spasms

Question 26

What are general characteristics of Ankylosing spondylitis?

Answer 26

a. Chronic inflammatory disease
b. Strong genetic predipostion
c. Mainly affects joints in the spin and SI joint

Question 27

What are general characteristics of spondyloisthesis?

Answer 27

a. Pain aggravated by bending, lifting, twisting.
b. Radiculopathy possible
c. Fatigue