Low back pain Flashcards
Causes of low back pain
Vertebral dysfunction -mcc**
Mechanical pain
Lumbar spondylosis (degeneration)
Spinal canal stenosis
Serious causes:
Osteomyelitis, TB
Epi/subdural abscess (IV drug users, fever)
Red flags of serious low back pain
- Age >50/<20 - osteoporosis
- H/o cancer esp prostate
- Fever
- Constant pain esp night
- Unexplained wt loss
- Trauma
- Other sys: breast lump, cough
- Neuro: numbness, paraesthesia getting worse
- IV drug abusers
- Steroids, anticoagulants
- Peripheral arthritis (spondyloarthropathy)
- Not better after 1 month
- Symptoms of cauda equina syndrome
-saddle anaesthesia
-bladder dysfunction/overflow incontinence(recent)
-B/l or progressive neurological deficit
Xray done if above criteria met as
mx for most of low back pain is the same
Inv of low back pain
- Initial - Xray
- Best - MRI»CT
Inflammation vs mechanical back pain
Inflammation:
1. Insidious onset
2. Aching/ throbbing
3. *Rest - exacerbates, activity - relieves
4. Worse early morning, night
Mechanical:
1. PPting factor +
2. Deep, sharp
3. *Rest - relieves, activity - exacerbates
4. Worse by end of the day
●Persistent, continuous pain - infection/neoplasia
●Pain ↑ with standing/walking, ↓with sitting - spondylolisthesis
●Pain ↑with sitting, ↓with standing/walking - discogenic
Persistent, continuous pain
infection/neoplasia
Pain ↑ with standing/walking, ↓with sitting
spondylolisthesis
Pain ↑with sitting, ↓with standing/walking
discogenic
Pain in calf, extending proximally while walking (hip/butt)
Vascular claudication
Pain in butt, descending to calf with walking
Neurogenic claudication (a/w spinal canal stenosis)
Vertebral dysfunction
- Facet joint dysfunction
- Age 22-55
- H/o injury (lifting/twisting)
- U/L, radiating to sacrum,
- Aggravated with activity
- localised tenderness at L4, L5, S1
- Clinical diagnosis (*inv shows normal - not needed)
- Initial mx - analgesics, continue activity, physio
Radicular pain/radiculopathy
Disc protrusion, neoplasia, narrowed intervertebral foramen …
compression of nerve root …
Pain to the dermatome of nerve compressed (L3- lower leg)
Leg/back pain
mc - disc lesion: L4-5, root compression L5, S1
Mx - avoid heavy lifting 6-12wks, spontaneous
(no need for inv)
Spondylolisthesis
- ↑standing, flexed knee stance
- Prominent, tender spine of slipped vertebra
- Limited flexion of vertebra
- Stiff, waddling gait
- Xray to confirm diagnosis (not needed)
- Analgesics, Mainly physio
Lumbar spondylosis
Degeneration
Osteoarthritis of lumbar vertebra
analgesics, continue activity, physio
Malignant diseases metastasising to bone, vertebra
Multiple myeloma
Osteosclerotic -
Prostate»breast»lung, pagets
Osteolytic -
Lung, breast, thyroid, kidney , skin
Mainstay rx of low back pain
- Advise to stay active
- Relative rest 2-3 days
- Exercise
- Basic analgesics(paracetamol, NSAIDs)
