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Neurology > Low Back Pain and Sciatica > Flashcards

Low Back Pain and Sciatica Flashcards

1
Q

What questions would you ask about character of back pain?

A
  • Dull
  • Stabbing
  • Throbbing
  • Burning
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2
Q

What questions would you ask about location and radiation of back pain?

A

Buttocks (muscle)

Below knee (maybe disc)

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3
Q

What questions would you ask about duration of back pain?

A

Acute vs subacute vs chronic

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4
Q

What associated symptoms of back pain need to be assessed?

A

Stiffness

Numbness/tingling

Urinary symptoms

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5
Q

What aggravating factors of back pain need to be assessed?

A

Certain positions (sitting)

Coughing

sneezing

Walking down the stairs

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6
Q

What relieving factors of back pain need to be assessed?

A
  • Certain positions
  • Non-pharmacological measures (massage, osteopath, acupuncture, PT)
  • Analgesia
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7
Q

Describe a history for back pain?

A

Past medical history

History of PC

  • onset
  • character
  • location and radiation
  • duration
  • intensity
  • associated symptoms

Systems review

Medical and surgical history

Drug history

Family History

Social History

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8
Q

What systems reviews need to be done in a presentation of back pain?

A
  • fever
  • appetite/weight loss
  • abdominal pain
  • cough/haemoptysia
  • dysuria/haemoturia
  • menstrual history
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9
Q

What questions about medical and surgical history must be asked?

A

Trauma

Previous operations including spine

Malignancy

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10
Q

What questions about drug history must be asked?

A

Corticosteroids

Immunosuppressants

Anti-platelet

Anticoagulant

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11
Q

What questions about family history must be asked?

A

Cancers

Back pain/spondyloarthropathies

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12
Q

What questions about social history must be asked?

A

Job (type of work, ?physical, level of activity)

Smoking history

Recreational drug use

Sporting activities

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13
Q

What needs to be determined and ruled out in a patient with lower back pain?

A

Determine the pain is intrinsic from the back and not referred from elsewhere

Rule out life-threatening disease

Determine whether root compression is present

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14
Q

What are the general red flags of back pain?

A
  • Failure to improve after 4-6 weeks of conservative therapy
  • Unrelenting night pain or pain at rest
  • Progressive motor or sensory deficit
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15
Q

What are the cancer red flags of back pain?

A
  • Age > 50
  • unintended weight loss
  • history of cancer
  • pain at night and in recumbency
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16
Q

What are the infection red flags of back pain?

A
  • fever/chills
  • recent infection
  • immunosuppression
  • IV drug use
  • Dental status
  • Foreign travel
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17
Q

What are the fracture red flags of back pain?

A
  • age > 50
  • osteoporosis
  • significant trauma
  • chronic steroid use
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18
Q

What are the cauda equina syndrome red flags for back pain?

A
  • bilateral sciatica
  • urinary incontinence
  • leg weakness
  • decreased anal tone
  • Loss of perianal sensation
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19
Q

What are the AAA red flags of cauda equina syndrome?

A
  • Age > 60
  • Abdominal pulsating mass
  • Pain at rest
20
Q

Describe examination in back pain

A
  • general appearance
  • vital signs
  • back examination
    • GAIT
      • heels
      • tip toes
    • LOOK: from side and back
    • FEEL: SPs, steps, SI joints
    • MOVE: flexion, extension, lateral bending, rotation
  • other tests
    • SLR
    • muscle strength
    • sensation
    • deep tendon reflexes
21
Q

Each joint movement consists of 4 consecutive spinal nerves;

Hip flexion ___and extension ___

Knee flexion ___ and extension ___

Ankle plantarflexion ____ and dorsiflexion ____
Foot inversion ___ and eversion ____.

A

Each joint movement consists of 4 consecutive spinal nerves;

Hip flexion L2,3 and extension L4,5

Knee flexion L5,S1 and extension L3,4

Ankle plantarflexion S1,2 and dorsiflexion L4,5
Foot inversion L4 and eversion L5,S1.

22
Q

Describe the grading of muscle power

A

0- Complete paralysis

1- Flicker of contraction possible

2- Movement possible if gravity eliminated

3- movement against gravity but not against resistance

4- movement possible against some resistance

5- power normal (it is not normally possible to overcome a normal adult’s power)

23
Q

Sensation across foot on both dorsal and plantar surfaces from medial to lateral is __-__-__

A

Sensation across foot on both dorsal and plantar surfaces from medial to lateral is L4-L5-S1

24
Q

Myotome dance

Neck flexion: __

Side bending: __

Shoulder elevation: __

Shoulder abductinon: __

Elbow flexion, wrist extension: __

Elbow extension, wrist flexion: __

Thumb extension: __

Finger abdunction: __

T2-T12

Hip flexion, knee extension, ankle dorsiflexion: __,_,_

Ankle dorsiflextion, toe extension: __-_

Hip extension: __

Knee flexion: __

A

Myotome dance

Neck flexion: C2

Side bending: C3

Shoulder elevation: C4

Shoulder abductinon: C5

Elbow flexion, wrist extension: C6

Elbow extension, wrist flexion: C7

Thumb extension: C8

Finger abdunction: T1

T2-T12

Hip flexion, knee extension, ankle dorsiflexion: L2,3,4

Ankle dorsiflextion, toe extension: L4-5

Hip extension: S1

Knee flexion: S2

25
Q

Which nerve roots are being compressed?

A

L4, L5, S1

26
Q

What spinal nerves are responsible for

Triceps reflex:

Biceps reflex:

Patellar reflex:

Achilles reflex:

A

Triceps reflex: C7, C8

Biceps reflex: C5, C6

Patellar reflex: L2, L3, L4

Achilles reflex: S1

27
Q

What investigations are done for non resolving back pain?

A

Radiology

  • X-ray
  • CT
  • MRI
  • Bone scan
  • PET/SPECT

Lab

  • FBC, U&E’S
  • Inflammatory markers
28
Q

When should x-rays be used?

A

NOT ROUTINELY

Young men: SI joint to exclude ank spon

Elderly: to exclude vertebral collapse, other fractures, malignancy

X-rays for deformity

29
Q

CTs have a limited application in acute LBP without….

A

Red flags

30
Q

What are CTs good for?

A

Bony pathology (trauma, tumours, infection)

Good: foreign bodies, implants

Spinal fusion planning

MRI contraindicated/not available

31
Q

What is MRI good for?

A

Details of soft tissues (including tumours, infection)

Some sequences good for new fractures

Bone oedema/microfractures

32
Q

Red flags –> ___
Neurological signs and symptoms –> ___

A

Red flags –> MRI
Neurological signs and symptoms –> MRI

33
Q

What is a radionucleotide bone scan used for?

A

Increased bone turnover

-fractures, osteomyelitis, paget’s disease, ank spondlyitis

Metastases

Tumours

-Osteoid osteoma

34
Q

What will PET scan show?

A

Increased uptake in high turnover areas

35
Q

Which laboratory tests are indicated if red flags are present?

A
  • malignancy (PSA, acid phosphatase, monoclonal bands)
  • Infection
  • Metabolic causes (alk phos, Ca2+, PO4, HLA B-27)
36
Q

What non-pharmacological intervention is there?

A
  • Explanation
  • Re-assurance
  • No bed rest
37
Q

What are the pharmacological interventions for LBP?

A
  • Regular analgesia, incl NSAIDS
    • Improve mobility
    • Facilitate exercise
  • Opiates for severe pain
    • Short term
    • Breakthrough only
    • TCAs
  • Injections
38
Q

What complementary and alternative medicine interventions are there?

A
  • acupuncture
  • chiropractor
  • osteopath
  • massages
  • physiotherapy
39
Q

When should LBP be investigated?

A

No improvement after 4-6 weeks

Red flags

40
Q

When should LBP be referred?

A
  • Intractable pain
  • Serious pathology suspected or suggested on initial imaging
  • Neurological deficit
41
Q

What are the risk factors for LBP?

A
  • previous back pain
  • heavy lifting/frequent bending
  • repetitive work with exposure to vibration
42
Q

What are the best ways of preventing back pain?

A
  • education
    • lifting, turning
    • mental coping strategies
    • stop smoking
  • physical activity
43
Q

What is the treatment plan for sciatica?

A

Initially conservative

Unless red flags: surgical intervention

44
Q

What is the DDx of sciatica?

A
  • Root compression by other degenerative disease
    • bone spurs, canal stenosis, spondylolisthesis, facet arthropathy
  • Root compression of sinister causes
    • (tumour, fractures, TB)
  • Root compression outside the spine
    • (piriformis syndrome, endometriosis, pelvic disease,peroneal compression…)
  • No root compression
    • (arachnoiditis, peripheral neuropathies)
45
Q

What is piriformis syndrome?

A

Tight piriformis compresses sciatic nerve

Neurology (41 decks)

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