Low back complaint Flashcards
red flags with low back pain
fever or recent infection, saddle anesthesia, severe or progressive neurological complaints, bladder dysfunction, unexplained weight loss, pain that is worse at night
management with signs of cauda equina or progressing neurological deficits
refer for neurological evaluation
management for suspected fracture, infection, or cancer
do xrays
pts with xrays or labs that show possible tumor, infection, or fracture
send for medical eval
pts who appear to have a mechanical cause of pain
manage conservatively
most likely diagnosis with urinary retention
cauda equina syndrome
pts over the age of 50, previous history of cancer, unexplained weight loss, failure to respond to conservative care, pain that is unrelieved by bedrest
possible cancer
pts with history of urinary tract infection, urinary catheter, injection of drugs, fever
possible infection (spinal)
older pts with sudden onset of pain with coughing sneezing or sudden flexion, unassociated with radicular complaints
possible compression fracture
low back pain with radiation pain below the knee suggests:
disc lesion with nerve root irritation
paresthesia or numbness more common with
disc lesions
low back pain with rapid onset of bilateral leg weakness
immediate medical referral
low back pain with fall on the buttocks or sudden hyperflexion injury
xrays to look for fracture
recent onset of associated urinary retention, with associated numbness in perianal or perineal areas, saddle thigh or buttocks sensory loss
cauda equina syndrome
recent onset of urinary retention with no numbness in perianal or perineal regoions
do UA, DRE and PSA in males
radiating pain into the groin area with associated fever/chills and positive punch test
pyelonephritis is likely
pt has posterior or lateral leg pain, paresthesia extending below the knee; SLR positive with hard neurological findings of a single nerve root
disc lesion
unilateral or bilateral diffuse leg complaints made worse by walking; pain relieved within 20 minutes of sitting or less severe with bicycling; multiple dermatome involvement; xray shows stenosis
neurogenic claudication
unilateral or bilateral diffuse leg complaints made worse by walking; pain not relieved within 20 min of sitting or less severe with walking
vascular claudication
leg pain, numbness, paresthesia in anterior thigh region; reproduction with femoral nerve stretch or Lindner’s
upper lumbar nerve root pathology
pain, numbness, paresthesia above knee; restricted motion or pain produced at SI with compression test, Gaenslen’s, Fabers
SI syndrome
pain, numbness, paresthesia above knee, positive Kemps and negative SLR
facet syndrome
pain localized to low back and made worse by movement, pain made worse with active movement in one direction
muscle strain likely
diffuse sensation of low back pain stiffness; positive 11/18 tender points
fibromyalgia likely
diffuse sensation of low back pain stiffness; no tender points; restricted ROM associated with SI pain and low back stiffness relieved by rest
AS should be considered
pt complains of low back and leg pain below the knee after a sudden onset from bending or twisting
disc lesion with radiculopathy
most disc lesions are at:
L4/L5 or L5/S1
weakness of dorsiflexion of great toe and numbness on lateral side of lower leg
L5 nerve root lesion
absent Achilles reflex, numbness on back of calf lateral foot or bottom of foot, weakness on plantar flexion of great toe
S1 nerve root lesion
in cervical spine, midline disc herniations create
myelopathies
in cervical spine, lateral disc herniation involves
nerve root below
in lumbar spine, midline disc herniation involves
nerve root below
in lumbar spine, foraminal disc herniation involves
nerve root at same level
disc lesion that affects S1 nerve root, pain projects to S1 area, achilles reflex affected, weak plantar flexion, difficulty with toe walking
L5/S1 disc lesion
disc lesion that affects L5 nerve root, sensory deficit in anterior lateral lower leg and top of foot, weak dorsiflexion of foot, difficulty with heel walking
L4/L5 disc lesion
pt leans way from side of disc lesion or pain
lateral disc lesion
pt leans into side of disc lesion or pain
medial disc lesion
pt assumes flexed posture with disc lesion
central disc lesion
pt complains of well localized low back pain with some hip/buttock/leg pain above the knee that has onset after sudden movement or getting up from flexed position
facet syndrome
pt that is 50 or older, unilateral or bilateral diffuse back and leg pain, onset of complaints with walking and is relieved with rest
canal stenosis
most common type of spondylo in the young
isthmic
most common type of spondylo in the old
degenerative
spondylo usually due to a stress fracture of the pars, most commonly at L5, younger age onset
isthmic/spondylolytic
spondylo usually associated with facet arthrosis, most commonly at L4, older age onset
degenerative
pt may have mid abdominal or low back pain, may have leg pain with exertion, may have abdominal mass and/or bruit, may have erosion of anterior vertebral bodies
abdominal aneurysm
pt has hard neurological evidence of nerve dysfunction, radiation of pain often into leg and foot pain, deficit in correspoinding dermatome myotome and DTR, variable muscle weakness
neuritis or radiculitis due to disc
primary site of mets in females
breast (usually lytic)
primary site of mets in males
prostate (usually blastic)
common tetrad of multiple myeloma (CRAB)
calcium, renal failure, anemia, bone lesions
