Low back notes Flashcards
what should you screen for when assessing LBP?
severe trauma fever or recent bacterial infection saddle anesthesia severe or progressive neurological complaints bladder dysfunction unexplained weight loss prior history of cancer IV drug use or immunosuppression pain that is worse at night
what questions should you ask with someone who has LBP
Trauma? Mechanism? Severity? is there leg pain? are leg complaints worse with coughing, sneezing or straining at the stool? weakness in legs with activity? difficulty with urination or defecation? adominal pain? weight loss? level of pain and functional capacity?
what do you do if there are signs of cauda equine?
refer for neurological evaluation
fracture, infection or cancer indicates what?
radiographs
if the clinical, radiographic or labs indicate tumor, infection or fracture, what should you do?
sent for medical evaluation and management
what do you do with patients that appear to have a mechanical cause of pain?
managed conservatively for one month
if unresponsive, further testing or referral for second opinion
what is the most sensitivty indicator for cauda equina syndrome?
urinary retention/overflow incontinence
low back pain due to cancer potential indicators
>50 previous history of cancer unexplained weight loss failure to respond to conservative care pain unrelieved by bed rest
low back pain due to spinal infection potential indicators
history of UTI urinary catheter injection of drugs skin infections fever (highly specific)
ominous conditions for older patients
sudden onset of pain with coughing, sneezing or sudden lfecion unassociated with radicular complaints should warrrant a search for potential compression fracture
signs and symptoms of LBP from a disc
pain travelling below the knee
paresthesia or numbness
history of recurrent episodes of back pain without leg pain
30-50 yo
may report twisting injury accompanied by immediate leg pain
younger patients with a disc lesion have pain when?
sitting
less with standing or walking
older patients with leg pain is more likely to have?
a compression insult of the nerve root due to various forms of stenosis
more difficulty with walking or standing because of the compressive effect
selected disorders of low back
disc lesion facet syndrome canal stenosis spondylolisthesis aneurysm
signs/symptoms of disc lesion with radiculopathy
30-50 yo
patient complains of low back and leg pain below knee
sudden onset from bending &/or twisting maneuver
several bouts of LBP that resolved
NR inflammed but not always compressed
what does herniated disc material cause?
release of irritating substances or initiates an autoimmune inflammatory reaction
when the ___ is compressed, frank neurological signs usually become evident
nerve root
98% of all disc lesions are at?
L4/5
L5/S1
weakness of dorsiflexion of great toe and numbness on lateral side of lower leg suggests
L5 NR lesion
L4 disc
L5 disc
S1 NR
absent achilles relfex, numbness on the back of the calf, lateral foot or torrom of the foot, weakness on plantar flexion of great toe or foot
what is a reliable nerve root sign?
SLR when positive for reproduction of leg pain below 45 degrees of elevation
valsalva
slump
what is a strong confirmation of a disc lesion
positive well leg raiser
braggard’s
when is confirmation of MRI or electrodiagnostic studies used for a disc lesion?
within the first 4 weeks if severe, unrelenting pain or progressive neurological signs
what are good ways to adjust people with disc lesions?
flexion disraction
blocking
activator
make sure ot tell them exactly what could happen
