Low Back Pain Flashcards
mechanical causes of low back pain
- myofascial or soft tissue strain/sprain
- spondylosis
- disc herniation
- osteoporotic vertebral herniation
- spinal stenosis
spinal causes of low back pain - do not miss
- malignancy
- infection
- spondyloarthropathies
- metabolic bone disease
- fibromyalgia
visceral/referred causes of low back pain
- abdominal aortic aneurysm
- ulcer
- pancreatitis
- cholecystitis
- pyelonephritis / nephrolithiasis
- prostatitis
- PID / endometriosis / ectopic pregnancny
- hip problems
low back pain - general RED FLAGS
*pain > 1 month
*unresponsive 1 month rest
*not relieved by rest
low back pain RED FLAGS for: cancer
- age > 50
- hx of cancer
- unexplained weight loss
low back pain RED FLAGS for: infection
- chronic steroid use
- IV drug use
- UTI or other infection
- feverw
low back pain RED FLAGS for: fracture
- age > 70 or < 20
- chronic steroid use
- bladder dysfunction
- significant trauma
low back pain RED FLAGS for: cauda equina syndrome
- saddle anesthesia
- major motor weakness
- bowel or bladder dysfunction
- reduced anal tone
- severe bilateral radiculopathy
indications for x-rays in low back pain
*not recommended in first month of acute LBP UNLESS:
-RED FLAGS
-significant changes in clinical picture
-chronic LBP with signs of tumor, infection, fracture
indications for MRI/CT in low back pain
*immediately order if red flags are present
*most with sciatica improve in 4-6 weeks (so don’t order before then)
recommended treatments for ACUTE nonspecific low back pain
*acetaminophen
*NSAIDs or COX2 inhibitors
*muscle relaxants
*local heat or ice
*moderate, low stress aerobic activity
*continuation of usual activities
*patient education
*cognitive-behavioral treatment
recommended treatments for CHRONIC nonspecific low back pain
*acetaminophen
*NSAIDs or COX2 inhibitors
*local heat or ice
*moderate, low stress aerobic activity
*continuation of usual activities
*trunk strengthening exercises
*patient education
*back school
*cognitive-behavioral treatment
*multidisciplinary bio-psychosocial rehab with intensive function restoration
lumbar disc herniation
*95% occur at L4-L5 and/or L5-S1
*peak ages 30-55 years old
*can cause low back pain, sciatica, or both
*can be asymptomatic
sciatica - history & physical exam
*classic: pain radiating into buttocks and down posterolateral leg below the knee
*worse with coughing, sneezing, sitting, valsalva
*PE: straight leg raise at 30-60 degrees elevation (supine or sitting) that reproduces sharp pain
spinal stenosis
*degeneration of the spine, causing narrowing of the spinal canal and neural outlets, often resulting in compression of nerve roots
*hypertrophy of ligamentum flavum and facet joints narrows the spinal canal
*can entrap nerve roots
*classically pain improves when leaning forward
*pseudoclaudication: low back and lower extremity pain and numbness worse with walking, standing, and extension
spondylosis
*arthritis of the spine
spondylolitsthesis
*anterior displacement of a vertebra compared to the one beneath it
sponylolysis
*fracture of the pars interarticularis (Scottie dog fracture)
findings of L4 nerve root compromise
*pain: lateral hip to anterior thigh & shin
*numbness: anterior low thigh & knee
*motor weakness: quadriceps extension
*screening exam: squat and rise
*reflex: patellar diminished
findings of L5 nerve root compromise
*pain: low back to lateral buttock to lateral thigh and lateral lower leg
*numbness: lateral lower leg
*motor weakness: dorsiflex great toe and foot
*screening exam: heel walk
*reflex: none
findings of S1 nerve root compromise
*pain: posterior buttock to posterior thigh & lower leg
*numbness: posterior lower leg & lateral foot
*motor weakness: plantar flex great toe & foot
*screening exam: walk on toes
*reflex: achilles diminished
positive straight-leg raise test
*pain, numbness, or tingling that goes past the knee
*generally associated with radiculopathy (disc herniation or nerve root compression)
note - pain in back/buttock/hamstring is NOT considered positive
