Lower Back Pain

Question 1

History taking for back pain

Answer 1

Character/location
onset
course
relationship to work/activity
exacerbating or relieving factors
prior tx 
litigation/work comp

Question 2

mechanical LBP

Answer 2

most common dx in adults

Frequently multifactorial

Question 3

mechanical lbp common causes

Answer 3

Muscle spasm
facet joint inflammation
SI joint dysfunction

Question 4

PE for LBP (mechanical)

Answer 4

Inspection, palpation, ROM, joint/muscle provocative tests, straight leg raises, neurologic testing

Question 5

Evaluation for mechanical lbp

Answer 5

Xray**
MRI
CT
TPBS
EMG

Question 6

mechanical lbp tx

Answer 6

TIME AND MOVEMENT
Early mobilization
physical therapy
core stabilization
adjustment/manipulation
massage (rolfing)

Question 7

Mechanical LBP prognosis and recurrence

Answer 7

35% in 1 mo
85-90% in 3 mo
95% in 6 mo

62% recur in 1 yr
80% in 2 yr

• manage and prevent

Question 8

Degenerative diseases

Answer 8

spinal stenosis
facet arthrosis
spondylolisthesis
sacroiliac arthrosis

Question 9

DJD/SS pathophysiology

Answer 9

gradual narrowing of spinal canal and/or neural foramina

osteophyte formation, facet hypertrophy, bulging disks, hypertrophy of ligamentum flavum

Question 10

DJD/SS Dx

Answer 10

low back pain radiating posteriorly to ankles and feet
symptoms worse w/ erect posture
numbness, tingling, foot drop
kip, knee, ankle, foot pain

Question 11

DJD/SS tx

Answer 11

TIME AND MOVEMENT
PT
meds (steroids, NSAIDs, narcotics)
Dorsal column stimulators
surgery (MAJOR)

Question 12

Spondylolisthesis

Answer 12

forward slipping of one vertebrae on another

Question 13

Spondylolisthesis clinical presentation

Answer 13

frequently asymptomatic
may be painful (motion, sleeping)
radicular sxs w/ nerve root irritation

Question 14

Spondy tx

Answer 14

non op - meds, PT, TENS

op only if progressive slip, uncontrolled pain

Question 15

Acute disc herniation presentation

Answer 15

LBP
identifiable precipitant
radicular sxs (sciatica)
sensory sxs
motor sxs

Question 16

Acute Disc herniation physical findings

Answer 16

Splinting (leaning)
+/- tenderness
straight leg raise
reflexes, motor function, sensory exam

Question 17

Acute disc herniation tx

Answer 17

TIME AND MOVEMENT
active rest
oral steroids
pain  meds
\+/- PT 
*not chiro
MOST GET BETTER W/OUT SURGERY

Question 18

Acute disc herniation indications for surgery

Answer 18

pain, corresponding lesion on MRI, radicular sxs, motor weakness, surgical candidate

Question 19

Acute disc herniation surgery

Answer 19

microdiscectomy

fusion

Question 20

causes of sciatica

Answer 20

disc disease
spinal stenosis
piriformis entrapment
peripheral entrapment
vascular claudication
others

Question 21

Back pain in children causes

Answer 21

mechanical (less common)
spondylolysis/spondylolisthesis
disc disease
tumor
infection
rheum
visceral
psychosomation

**Usually more serious and need to follow up

Question 22

What to know about child back pain (hx)?

Answer 22

location, precipitants/modifiers, activity, radicular sxs, constitutional sxs, associated sxs, home stressors

Question 23

Back pain in children - dx

Answer 23

Xrays - 5 view
TPBS ***
MRI
CT
\+ lab work (less likely - CBC, CRP, ESR, rheum, LP, EMG)

Question 24

spondylolysis tx in kid

Answer 24

activity modification
time
bones stimulator
bracing, surgery?