Lower back pain and sciatica Flashcards
1
Q
What is mechanical back pain?
A
- pain arises from the spinal joints, vertebrae or soft tissues and is exacerbated by movement
2
Q
What are the 2 classifications of LBP?
A
- Acute (< 6weeks)
- Chronic (> 6weeks)
3
Q
What are the causes of lower back pain?
A
- Nonspecific low back pain (most common)
- Intervertebral disc prolapse
- vertebral fracture
- facet joint injury
- ankylosing spondylitis
4
Q
What is the peak age group for low back pain?
A
- 41-50 yo
5
Q
What are the RF of LBP?
A
- Highly demanding jobs
- prolonged standing
- awkward lifting
- obesity
- FHx
6
Q
What questions would you include when taking Hx of LBP?
A
- when the pain started
- pain was sudden or gradual in onset.
- location of the pain.
- pain radiation to anywhere else.
- aggravating or relieving factors.
- Confirming whether the patient has had this problem previously.
- Noting the patient’s occupation, hobbies or sport.
- confirm what they think caused the pain.
- Noting past medical history.
- Steroid use predisposes to osteoporosis.
- Establish whether there has been malignancy that metastasises to bone (lung, breast, prostate, thyroid, kidney) or myeloma.
- Asking the patient how they have been managing the condition
7
Q
How would you examine LBP?
A
- Preparation
- Undress
- Expose spine
- Have patient standing
- Examination
- inspection
- palpation
- brief neurological examination
- assessment of function
- Assess red flags
- Cauda equina syndrome
- Spinal #
- Cancer/infection
8
Q
What are the red flags for CES?
A
- Saddle anaesthesia
- Recent onset of bladder dysfunction.
- Recent onset of faecal incontinence.
- Perianal/perineal sensory loss.
- Unexpected laxity of the anal sphincter.
- Severe or progressive neurological deficit in the lower extremities.
9
Q
What are the red flag sx for spinal #?
A
- Sudden onset of severe central pain in the spine which is relieved by lying down.
- Major trauma
- Minor trauma in people with osteoporosis.
- Structural deformity of the spine
- Point tenderness over the vertebral body.
10
Q
What are the red flag sx for cancer/infection of spine?
A
- Pain that remains when lying down
- pain that disturbs sleep
- Onset in people aged above 50 years or below 20 years.
- History of cancer.
- Constitutional symptoms, such as fever, chills, or unexplained weight loss.
- Recent bacterial infection - eg, urinary tract infection.
- Intravenous drug misuse.
- Immune suppression.
- Structural deformity of the spine (such as scoliosis).
- Point tenderness over the vertebral body.
11
Q
What are the differential diagnosis for back pain?
A
- Primary malignancy
- myeloma
- Secondary cancers
- lung, breast, prostate, kidney, thyroid
- Bone disorder
- Paget’s disease
- Osteoporosis
- Spinal stenosis
- Inflammatory disease
- Ankylosing spondylitis
- Infection
- TB/ osteomyelitis
- Non spinal related
- Dissecting aortic aneurysm
12
Q
What Ix would you order for LBP?
A
- If simple LBP - no need Ix
- Imaging
- Xray of lumbar spine -
- only if fracture or mets suspected
- not routinely used as very high radiation exposure
- CT
- for stress fractures
- for spondylolisthesis
- MRI
- for disc lesion, nerve root compression, discitis
- Xray of lumbar spine -
13
Q
What other ix would you order for LBP?
A
- FBC, ESR, CRP, urine analysis if cancer, infection or inflammation is suspected
- LFTs - Alkaline phosphatase can be elevated in metastatic disease and Paget’s disease of bone.
- PSA - raised in carcinoma of the prostate.
- Urinary hydroxyproline- raised in Paget’s disease of bone.
14
Q
How would you mx simple LBP?
A
- Conservative
- reassurance and advice
- advise to stay active
- reduce RF
- Pharmacological
- First line
- NSAIDs - low dose, short course
- Muscle relaxant
- Second line
- weak opioids
15
Q
What does yellow flags mean in LBP?
A
- psychosocial barriers to active rehabilitation
