Low Back Pain Flashcards
Is LBP suspected if pain in legs?
no, more nerve root impingement
Red flags for LBP?
night sweats pn at night pn at rest unexplained weight loss failure to improve with therapy severe pain for 6+ weeks urinary/bowel incontinece/retention (cauda equina)
is LBP 2nd most sought visit to primary care?
true , LBP most common cause of diability in pt under 45
how quickly do most LBP resolve?
80% in 2 weeks
90% in 6 weeks
risk factors for LBP due to cancer
history of cancer
50 y.o. +
cauda equina S&S
urinary retention/incontinence (bowel too)
decreased anal spincter tone
bilateral LE weakness
progressive neuro involvement
risk factors of LBP due to compression fractures
70 y.o.+
corticosteroid use
osteoporosis
recent trauma
one leg standing test then extend spine tests for what?
PARS interarticularis fracture (spondylosis or spondylolisthesis)
LE reflexes
knee/patellar- femoral N (L2-L4)
ankle- deep peroneal N (L4-L5)
babinski- sciatic (L5-S1)
LE Myotome
L1- hip flex L2- hip flex L3- knee ext L4- DF L5- Great toe ext S1- PF, knee flex S2- Knee flex S2-S4- external anal sphincter
AHRQ criteria for Lumbar radiograph with acute LBP
major trauma minor trauma if 50+ osteoporosis long-term corticosteroid use 70 +
if SLR, and pain contralateral leg lifted? what is problem?
Large disc herniation
if ipsilateral leg (sciatica, neural foraminal stenosis)
Conservative Treatment of LBP
pt education (lifting techniques)
core strength
heat/cold for temporary relief (not long term)
NSAID- effective early on
Muscle relaxants- if true muscle spasms, not if protective spasm
opiods- Alpha-2-delta ligans (gabapentin), serotonin-norepinepthrine reuptake inhibitor (duloxetine), or tricyclic antidepressants (nortriptyline)
non-conservative treatment of LBP
better prognosis if anatomic lesion is fixed
when to refer LBP
Cauda equina syndrome
Cancer, infection, severe spinal deformity
not respond to conservative care
