Low Back Pain Flashcards
What are some red flags of lower back pain?
Neuro deficit, unexplained weight loss, history of malignancy, systemic steroids
Age > 50 yo, trauma, substance abuse, ankylosing spondylitis, night pain, fever > 100F, persistent pain, pain with lying down, bowel/bladder dysfunction
What are some yellow flags of lower back pain?
Non-availability of modified work, ratio of compensation to pre-injury wage
Explain the pathophys of low back pain
Multifactoral biopsychosocial pain
Nerve compression
Spasm –> Pain –> Spasm
What are some common causes of lower back pain?
Idiopathic (MC), degenerative disks & facets, herniated disk, spinal stenosis, osteoporotic compression fx, spondylolisthesis
A 49 yo man presents complaining of lower back pain. He first noticed the pain a couple weeks ago after shoveling a lot of heavy snow. What treatment do you recommend?
Acute phase LBP
Control pain, minimize activity
Anti-inflammatories, Tramadol, opioids, muscle relaxants (methocarbamol)
A 65 yo obese male with a 20 year pack history presents complaining of bilateral pain in his lower back. He says he first noticed it 6 weeks ago after sitting for a prolonged time and it hasn’t gone away since. What diagnostics should you order? How will you treat?
Subacute phase LBP
Order XRay b/c of age and duration (he’s shown no improvement in 6 wks)
Control pain, maximize activity
Anti-inflammatories, tramadol, opioids, muscle relaxants (methocarbamol)
Exercise helps prevents acute LBP
A 28 yo female presents complaining of lower back pain. She is 7 months pregnant and has been doing a lot of work putting together the crib in the babies room, moving around furniture, and getting the nursery ready. She has only noticed the pain for the past week or so. What should you recommend?
Acute phase LBP
Control pain, minimize activity
Anti-inflammatories, Tramdol, opioids, muscle relaxants (methocarbamol)
Reduce activity levels and avoid heavy lifting
A 68 yo female presents complaining of bilateral lower back pain for the past 7 weeks. She first noticed the pain after sitting down hard on a stone bench in the park. What are you worried about? What should you do?
Osteoporotic compression fx
Order X-ray to look for fx
Control pain (anti-inflammatories, tramdol, opioids, muscle relaxants/methocarbamol)
A 17 yo male athlete presents complaining of 2 months of lower back pain. X-ray shows a “scotty dog fracture”. What is your diagnosis?
Spondylolysis
A 62 yo male presents complaining of lower back pain for the past 4 months. What approach should you take when treating this pt?
Chronic LBP
Multidisciplinary
A pt presents with lower extremity paralysis and saddle anesthesia. He mentions urinary retention, but then when his bladder feels really full he is incontinent. What do you suspect? What is the pathophys behind his problem?
Cauda Equina Syndrome
Compression of the descending lumbrosacral nerve roots
A pt presents with saddle anesthesia, LE paralysis, and urinary retention w/ overflow incontinence. What are the 2 most likely etiologies?
Cauda Equina Syndrome
Massive midline disk herniation
Tumor
A pt presents with sensory loss in the dorsum of his foot and great toe, anterior tibialis weakness, hip abductor weakness, and pain down the side of his leg. What do you suspect?
L5 nerve root compression
A pt presents with a decreased Achilles reflex, sensory loss of his lateral foot and small toe, weakness of his gastrocnemius, gluteus maximus, plantar flexor, and great toe, and pain down the back of his leg into the bottom and side of his foot. What do you suspect?
S1 nerve root compression
A pt presents with leg and back pain, although the leg pain in worse than her back pain. The pain radiates down her posterior leg past her knee, but is better with lying down or standing (compared to sitting). On exam she has a decreased Achilles reflex and a + straight leg raise. What do you suspect?
Herniated nucleus pulposus
