Lower back pain

Question 1

Red flags

Answer 1

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

Question 2

Features of facet joint pain

Answer 2

May be acute or chronic
Pain worse in the morning and on standing
On examination there may be pain over the facets. The pain is typically worse on extension of the back

Question 3

onset of spinal stenosis

Answer 3

gradual

Question 4

features of spinal stenosis

Answer 4

Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking.

Resolves when sits down.

Pain may be described as ‘aching’, ‘crawling’.

Relieved by sitting down, leaning forwards and crouching down

Question 5

Ix of spinal stenosis

Answer 5

Clinical examination is often normal

Requires MRI to confirm diagnosis

Question 6

Typical presentation of ankylosing spondylitis

Answer 6

a young man who presents with lower back pain and stiffness

Question 7

Features of ankylosing spondylitis

Answer 7

Stiffness is usually worse in morning and improves with activity

Peripheral arthritis (25%, more common if female)

Question 8

features of Peripheral arterial disease

Answer 8

Pain on walking, relieved by rest
Absent or weak foot pulses and other signs of limb ischaemia
Past history may include smoking and other vascular diseases

Question 8

features of Peripheral arterial disease

Answer 8

Pain on walking, relieved by rest
Absent or weak foot pulses and other signs of limb ischaemia
Past history may include smoking and other vascular diseases