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PTHER 577 > LOW BACK PAIN > Flashcards

LOW BACK PAIN Flashcards

1
Q

What is mechanical LBP?

A

Pain arising from MSK structures of the spine

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2
Q

What is referred pain?

A

Pain that is perceived in a region remote from the actual source of the pain

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3
Q

What are the discriminating features of mLBP?

A
  • most episodes resolve < 4 weeks
  • back dominant pain
  • poorly localized
  • no neuro symptoms
  • no red flags
  • SLR negative
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4
Q

What are the defining features of mLBP?

A
  • age 20-55
  • 85-90% of LBP episodes
  • bettered/worsened with positioning
  • generally well, no systemic symptoms
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5
Q

How do we treat mLBP?

A

Treat

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6
Q

What is radicular pain?

A

Leg pain arising from inflammation or ischemia or a nerve root

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7
Q

What can cause radicular pain?

A

Disc herniation at L4-L5 or L5-S1

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8
Q

How does radicular pain differ from radiculopathy?

A

Radicular pain is sensitization-related (affects sensory fibres = shooting pain), while radiculopathy is neurological-related (affects motor fibres = conduction loss)

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9
Q

What are the discriminating features of radicular pain?

A
  • leg dominant pain
  • constant and severe
  • neuro symptoms in leg
  • SLR positive
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10
Q

What are the defining features of radicular pain?

A
  • age 20-55
  • 5-8% of LBP episodes
  • always referred leg pain
  • sharp, shooting pain
  • better/worse with changes in movement
  • generally well
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11
Q

How do we treat radicular pain?

A

Can be monitored or managed unless there is significant radiculopathy, failure to improve

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12
Q

What is ankylosing spondylitis?

A

Progressive chronic inflammatory arthropathy affecting the SI joints and axial skeleton

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13
Q

What is the pathology of AS?

A

Inflammation of joints causes fusion of bones = bamboo spine

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14
Q

What are the discriminating features of AS?

A
  • younger age 15-40
  • alternating buttock pain
  • morning stiffness > 30 mins
  • night pain
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15
Q

What are the defining features of AS?

A
  • males more than females
  • slow onset
  • back pain better with exercise
  • failure to improve after 3 months
  • uveitis
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16
Q

What is the decision for AS?

A

Refer GP for follow-up

17
Q

What is cauda equina syndrome?

A

Compression of dural sac and descending nerve roots below conus medullaris (L4)

18
Q

What are the discriminating features of CES?

A
  • new urinary retention
  • new fecal incontinence
  • new saddle anesthesia
19
Q

What are the defining features of CES?

A
  • age 20-55
  • males more than females
  • severe back pain
  • radicular leg pain
  • leg weakness
  • rapidly progressing
20
Q

What is the course of action for CES?

A

True emergency - escort/send to EMERG

21
Q

What are the discriminating features of a spinal fracture?

A
  • history of trauma
  • abrasion/contusion from trauma
  • more males than females
  • age > 50 (higher for 65+
  • prolonged steroid use (> 7.5 mg for 3 months)
22
Q

What are the defining features of a spinal fracture?

A
  • severe back pain
  • may have kyphotic deformity
  • difficulty WB
  • history of osteoporosis
23
Q

What is the course of action for a spinal fracture?

A

Urgent referral - send to EMERG

24
Q

What is a spinal infection?

A

Involves osteomyelitis of the v body = infect IVD

25
Q

What are the discriminating features of a spinal infection?

A
  • history of recent surgery
  • history of recent infection
  • fever, chills, sweating
26
Q

What are the defining features of a spinal infection?

A
  • slow insidious onset of back pain
  • non-mechanical behaviour
  • slowly worsening
27
Q

What is the course of action for a spinal infection?

A

Urgent referral - contact GP or refer to EMERG

28
Q

What are the discriminating features of spinal metastases (malignancy)?

A
  • age > 50 (higher for 65+)
  • worsening
  • history of cancer (lung/breast/GI/prostate)
  • new unexplained weight loss
29
Q

What are the defining features of spinal metastases?

A
  • unexplained deep bone pain
  • night pain
  • feeling unwell

PTHER 577 (5 decks)

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