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RHEUM / MSK Shapcott > Low Back Pain > Flashcards

Low Back Pain Flashcards

1
Q

90% lumbar ridiculous this involve what 2 roots?

A

L5

S1

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2
Q

Define spondylosis

A

Degenerative arthritis affecting the spine

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3
Q

Define spondylolisthesis

A

Thickening of ligamentum flavum

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4
Q

Most common cause of spinal stenosis

A

Spondylosis

Spondylolisthesis

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5
Q

Pain with ambulation localized to calf & distal lower extremity resolving when sitting / leaning forward

A

Pseudoclaudication
Neurogenic claudication
Spinal stenosis

All are synonyms.

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6
Q

Inflammatory back pain

A

Morning stiffness
Improvement with exercise
Pain @ night
Extraskeletal Sx (ex: uveitis)

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7
Q

Causes of low back pain that are not from the spine

A 
Pancreatitis
Nephrolithiasis
Pyelonephritis 
AAA
Herpes zoster
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8
Q

Clinical entitities associated with low back pain

A
  1. Piriformis syndrome
  2. SI joint dysfunction (controversial if this even exists)
  3. Bertolotti syndrome (back pain in setting of transitional vertebra–a common finding on imaging: congenital anomaly with naturally occurring articulation / bony fusion btwn transverse process L 5 & sacrum. Treat as if they have nonspecific back pain. Whether/when surgery is indicated is not clear.
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9
Q

Back pain radiating to buttock / lateral thigh / lateral calf / Dorsum of foot / great toe

A

L5 radiculopathy

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10
Q

Back pain radiating into buttock, lateral/posterior thigh, posterior calf, lateral or plantar foot

A

S1 radiculopathy

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11
Q

Sensory loss to lateral calf, Dorsum foot, web space btwn 1st & 2nd toe

A

L5 Radiculopathy

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12
Q

Sensory loss to posterior calf, lateral or plantar aspect of foot

A

S1 radiculopathy

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13
Q

Inguinal pain & numbness

A

L1 radiculopathy

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14
Q

Achilles stretch reflex loss

A

S1 radiculopathy

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15
Q

Semitendinosis/semimembranosus (internal hamstring) tendon loss of reflex

A

L5 Radiculopathy

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16
Q

Waddell’s signs of inorganic back pain

A

Superficial tenderness
Straight leg test that improves with distraction
Pt over-reaction during physical exam
Nondermatomal sensory loss
Sudden giving way/jerky movements on motor exam
Inconsistency with spontaneous activity (getting dressed, etc)
Inconsistency on formal motor testing

Presence of multiple above components suggests psychogenic contribution to pain

17
Q

When should you get ESR/CRP in back pain eval

A

If you suspect infxn / malignancy

18
Q

Prevalence of disc herniation on MRI in asymptomatic ppl

A

Up to 70%

19
Q

% of MRI in asymptomatic ppl showing spinal stenosis

A

21% of pt > 60 y/o

20
Q

Significance of annular tears

A

No correlation with back pain in some studies

21
Q

Significance of schmorl’s node

A

Herniated nucleus pulposis into adjacent end plate
Associated with degenerative changes, but not an independent risk factor for back pain

Seen in 20% pt asymptomatic on MRI

22
Q

Significance of modic changes

A

Unknown significance

*specific signal changes in vertebral end plate & adj bone marrow on spine MRI

23
Q

MRI back with contrast

A

Distinguish scar from disc in pt with prior back surgery

24
Q

Suspect osteomyelitis in pt who cannot get MRI

A

Radionuclide scan

25
Q

Imaging indication low back pain

A

Severe / progressive Neuro deficit or when serious underlying conditions are suspected

26
Q

Pt > 50 y/o, failed trial of PT for LBP

A

Get imaging

27
Q

Ankylosing spondylitis risk factors that warrant imaging

A

Morning stiffness that improves with exercise
Alternating buttock pain
Awakening from back pain in second part of night

28
Q

Risk factors for compression Fx that warrant imaging

A 
Osteoporosis
Glucocorticoid
Significant trauma
F> 75 y /o
M > 65 y/o
29
Q

Indication for MRI in radicular low back pain

A

L 4/5 or S1 radicular Sx or positive straight leg test who are candidates for injections or surgery

30
Q

Indications for MRI in spinal stenosis

A

Candidate for surgery

31
Q

Low back pain
New urinary retention
Fecal or urinary incontinence
Saddle anesthesia

A

Emergent MRI: cauda Equina syndrome

32
Q

Low back pain

Progressive motor weakness / motor weakness at multiple levels

A

Emergent MRI

33
Q

Hx of CA, low back pain Initial w/u

A

Plain films + CRP/ESR if on DDx, but if high clinical suspicion, proceed directly to emergent MRI

34
Q

Concern for infxn in low back pain present, but not high suspicion

A

Plain films, CRP/ESR. If high suspicion, proceed directly to emergent MRI

RHEUM / MSK Shapcott (2 decks)

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