Lower Back Pain

Question 1

Facet joint

Answer 1

May be acute or chronic
Pain worse in the morning and on standing
OE - pain over the facets, pain is typically worse on extension of the back

Question 2

Spinal stenosis

Answer 2

Usually gradual onset
Unilateral or bilateral leg pain (+/- back pain), numbness, weakness which is worse on walking which resolves when sitting down
Pain described as ‘aching’, ‘crawling’
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
MRI to confirm diagnosis

Question 3

Ankylosing spondylitis

Answer 3

Young man presents with lower back pain and stiffness
Stiffness is usually worse in morning and improves with activity
Peripheral arthritis (25%, more common if female)

Question 4

Peripheral arterial disease

Answer 4

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