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OS III Midterm > Low Back Pain DSA > Flashcards

Low Back Pain DSA Flashcards

1
Q

True or False: low back pain is the leading cause of disability

A

True, it forces more people into premature retirement than heart disease, diabetes, HTN, neoplasms, respiratory disease, and asthma combined

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2
Q

True or False: low back pain is common in children

A

True! The prevalence of low back pain in children is just as high as in adults

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3
Q

What are the characteristics of acute low back pain?

A
  • less than 12 weeks
  • high likelihood to resolve (80%)
  • no residual loss of fxn
  • simple or even no mgmt req’d
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4
Q

What are the characteristics of chronic low back pain?

A
  • longer than 12 weeks
  • high risk for loss of fxn and disability
  • treatment resistant (requires multiple modalities)
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5
Q

What are common risk factors for low back pain?

A
  • lifting weight at work (amt. and number of lifts)
  • smoking
  • depression
  • obesity
  • inactivity
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6
Q

What are common protective factors against low back pain?

A
  • regular exercise

- education w/ exercise

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7
Q

What is the primary cause of low back pain?

A

non-specific musculoskeletal (70%)

degenerative disc, spondylolisthesis (10%)

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8
Q

While visceral etiologies only account for 2% of low back pain, what are some examples of these visceral etiologies?

A
  • referred pain from GI organs (pancreatitis, PUD)
  • AAA
  • referred pain from GU organs (prostatitis, PID)
  • referred pain from renal problems (pyelonephritis)
  • endometriosis
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9
Q

While non-mechanical etiologies only account for 1% of low back pain, what are some examples of those etiologies?

A
  • neoplasms (metastasis, multiple myeloma, lymphoma)
  • infection (osteomyelitis, spinal abscess, shingles)
  • inflammatory (ankylosing spondylitis, psoriatic arthritis)
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10
Q

What muscles are common injured in strains and overuse injuries that cause low back pain?

A
  • multifidus and rotatores (paraspinal muscles)
  • erector spinae
  • quadratus lumborum
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11
Q

What ligaments are commonly injured in sprains that cause low back pain?

A
  • iliolumbar ligament

- posterior sacroiliac ligament

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12
Q

What are the characteristics of piriformis syndrome?

A
  • hypertonic piriformis that entraps the sciatic n.
  • aching burning pain in gluteal region down back thigh
  • pain worse when sitting
  • Dx by physical exam, FAIR (F, ADD, IR)
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13
Q

What are the origin and insertion of the piriformis?

A

anterior sacrum —> greater trochanter

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14
Q

What are characteristics of psoas syndrome?

A
  • chronic hypertonicity of psoas muscle
  • pt.’s will hunch the lumbar spine to “splint”
  • pain originating at thoracolumbar jxn
  • pain worse with lumbar extension or standing straight
  • Dx by muscle palpation, Thomas test
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15
Q

What are the characteristics of Short Leg Syndrome?

A
  • -anatomic leg length discrepancy, sacral base unlevel
  • -common w/ scoliosis
  • -pain worse w/ activity and when walking
  • -Dx by physical exam and pelvic side shift test
  • -Dx by postural x-ray or comparing medial malleolus
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16
Q

What is the treatment for a leg length discrepancy that has been gradual or long-standing?

A
  • -heel lift therapy if discrepancy is >5mm or >0.2in
  • -add one-eighth to one-sixteenth inch every 2wks

–final lift height should be one-half to three-fourths of the measured discrepancy

17
Q

What is the treatment for a leg length discrepancy that happens as an acute change?

A

-replace the full discrepancy immediately

18
Q

What are the characteristics of spondylolysis?

A
  • defect or stress fracture of pars interarticularis
  • usually asymptomatic (6-11% of adult population)
  • pain common at L5 vertebra
  • risk for young athletes w/ stress on developing bone
  • worse w/ hyperextension
19
Q

How is spondylolysis diagnosed?

A

“Scottie Dog” on x-ray

20
Q

What are the characteristics of spondylolisthesis?

A

-anterior displacement of vertebra secondary to bilateral pars defects

  • higher risk w/ age and osteoarthritis
  • pain worse with extension and activity
  • palpable “step off” on physical exam
21
Q

What are the characteristics of a compression fracture?

A
  • ->20% loss of vertebral height, chronic or acute
  • -can be asymptomatic or acute lower thoracic pain
  • -higher risk w/ age, osteoporosis, menopause
  • -pain worse w/sitting, extension, Valsalva, mvmt
  • -Dx by x-ray
22
Q

What are the characteristics of spinal stenosis?

A
  • narrowing of the neural foramen
  • unilateral numbness and tingling (usually L4-S1)
  • higher risk w/ age and osteoarthritis
  • pain worse when standing and walking
  • pain better with F, leaning over, sitting or lying down
23
Q

How is spinal stenosis diagnosed?

A

-MRI

24
Q

What are the characteristics of a herniated disc?

A

-compression of a nerve root due to herniation of nucleus pulposus through annulus fibrosus

  • pain commonly b/w L4-S1; worse with flexion
  • higher risk w/ occupations that involve twisting
  • Dx by MRI
25
Q

What are the characteristics of Cauda Equina Syndrome?

A
  • massive disc herniation compressing cauda equina
  • numbess/tingling in perineum (saddle anesthesia)
  • fecal/urinary incontinence
  • increased risk w/ trauma
  • worsens over time (emergent situation)
26
Q

How is Cauda Equina Syndrome diagnosed and treated?

A
  • MRI

- emergent spinal decompression

27
Q

What are some red flags in low back pain?

A

-progressive lower extremity weakness
(progressive radiculopathy)

-saddle anesthesia or loss of bowel/bladder control
(cauda equina syndrome)

  • deep bone pain or unexplained weight loss (neoplasm)
  • fever and chills (osteomyelitis)
28
Q

True or False: Do not order imaging for low back pain within the first 6wks unless there is progressive neurologic deficit

A

True; start w/ conservative treatment b/c the majority of low back pain resolves in < 12 wks (including radiculopathy w/o progressive deficit)

  • imaging incurs risk of radiation and costs time and $
  • low likelihood imaging will alter treatment

OS III Midterm (13 decks)

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