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Family Medicine Cases > Lower Back Pain > Flashcards

Lower Back Pain Flashcards

1
Q

How long does it take for most lower back pain problems to resolve?

A

2 to 4 weeks

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2
Q

97% of all back pain

A

Mechanical

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3
Q

Most common mechanical causes of back pain

A

Lumbar strain- 70%
Degenerative joint changes- 10%
Herniated disc- 4%

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4
Q

Risk of low back pain

A 
Prolonged sitting
Deconditioning
Poor lifting techniques
Repetitive lifting
Congenital causes
Obesity
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5
Q

Red flags

A 
Fever
Weight loss
Pain at night
Bowel or bladder issues
Neurological symptoms
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6
Q

Classic disc herniation

A 
Worse with sitting or bending
Better when laying or standing 
Others
- Radiation down leg
- Paresthesia
- Weakness
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7
Q

Night pain or pain at rest is a red flag for

A

Cancer

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8
Q

Hx of IV drug use is a red flag for

A

Infection

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9
Q

Major muscle weakness or foot drop is red flag for

A

Significant herniated nucleus pulposus

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10
Q

Chance of returning to work if out for 6 months? At 2 years?

A

50%

Almost 0

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11
Q

Systematic order of performing a physical exam for back pain

A

Standing
Sitting
Supine

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12
Q

Basic components

A

Inspection
Palpation
ROM

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13
Q

Restriction or pain with flexion indicate

A

Herniation
OA
Muscle spasm

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14
Q

Pain with extension

A

Degenerative disease

Spinal stenosis

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15
Q

Pain on same side as lateral motion

A

Bone pathology (OA or compression)

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16
Q

Pain on opposite side as lateral motion

A

Muscle strain

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17
Q

Difficulty walking on heal

A

L5 herniation

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18
Q

Difficulty walking on toe

A

S1 herniation

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19
Q

Pain is reduced while squatting

A

Central spinal stenosis

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20
Q

(+) tripod sign

- Modified straight leg test

A

Structural disease

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21
Q

In what position should you do a neurological exam

  • Reflexes
  • Strength
  • Sensation
A

Sitting

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22
Q

What are the main nerve roots to focus on

A

L4 through S1

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23
Q

Great toe

A

L5

24
Q

Lateral malleolus and posterolateral foot

A

S1

25
Q

4+ gradding on reflexes

A

Clonus

26
Q

Decreased patella reflex

A

L3 to L4 impingement

27
Q

Decreased achilles reflex

A

L5 to S1 impingement

28
Q

Hyper-reflexia

A

Upper motor neuron sign

- Spinal cord compression

29
Q

Hip flexion

A

L2 to L4

30
Q

Hip abduction

A

L4 to S1

31
Q

Hip adduction

A

L2 to L4

32
Q

Knee extension

A

L2 to L4

33
Q

Knee flexion

A

L5 to S2

34
Q

Dorsiflexion

A

L4 & L5

35
Q

Plantar flexion

A

S1 & S2

36
Q

Decreased strength

A

Nerve impingement

37
Q

Passive straight leg test

A

SLR or Lasegue’s sign

38
Q

Pain with dorsiflexion (SLR)

A

Sciatic issue over tight hamstring

39
Q

Pain radiates down posterior/lateral side of leg

A

+ SLR

S1 or L5

40
Q

Pain if leg is raised less than 30

A

Malingering

41
Q

Pain on opposite side of raised leg

A

Significant nerve root compression due to central disc herniation

42
Q

Positive crossed leg raise

- Asymptomatic leg is raised

A

Significant central herniation

- .9 specificity, not great sensitivity

43
Q

Positive FABER

- Flexion, Abduction, & External rotation

A

Sacroiliitis

44
Q

Pain worse with movement and sitting

A

Suggestive of mechanical pain

45
Q

Pain radiating down leg & numbness

A

Suggest disc herniation

46
Q

Pain improves in supine position

A

Suggest spinal stenosis or herniation

47
Q

How soon should decompression done for cauda equina syndrome

A

72 hrs

48
Q

Localizable bony tenderness
Dull, throbbing pain with slow progression
Worse with recumbency or cough

A

Malignancy

49
Q

15 to 40 yr old

Morning stiffness and achiness over SI joint or lumbar spine

A

Ankylosing spondylitis

50
Q

Aching back and posterior thigh discomfort

Increases with activity or bending

A

Spondylolisthesis

51
Q

Studies for low back pain

A

CBC: Cancer of infection
X-ray: Specific guidelines
Lumbar Spine Film: Specific guidelines
MRI: Specific guidelines

52
Q

X ray

A 
Trauma
Osteoporosis or Steroid use
 70
Cancer or signs of cancer
Pain worse when supine or severe at night
53
Q

Lumbar spine

A 
> 50
Trauma
Neurological deficits
Weight loss
Hx of ankylosing spondylitis 
Drug or alcohol abuse
Hx of malignancy
Fever
No improvement (no financial compensation)
54
Q

MRI

A 
Neurological deficits
Radiculopathy
Progressive motor weakness
Cauda equina 
Systemic disorders
Failed 6 weeks of conservative care
55
Q

Bottom line of imaging

A

If no red flags are present do not image until 6 weeks

56
Q

Therapy for back pain

A

NSAIDs
Local therapy (Hot/Cold)
Normal activity
PT (?)

57
Q

Options if pain has no resolution follow appropriate conservative management

A

Refer to spine surgeon or pain clinic
- Progression or poor pain control
Continue conservative treatment (If no red flags)
- Ok to DC PT if patient has been getting and not had relief

Family Medicine Cases (13 decks)

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