Lumbosacral Sprain and Strain I Flashcards
What are the primary reasons of adults for an office-based doctor visit?
- Hypertension
- Pregnancy care
- Checkups, well care
- Upper respiratory infections (colds)
- Low-back pain
- Depression and anxiety
- Diabetes
What is myth 1 about low back pain?
If you have a slipped disk you must have surgery
Surgeons agree about exactly who should have a surgery
What is myth 2 about low back pain?
X-ray and newer imaging can always identify the cause of back pain
What is myth 3 about low lack pain?
If your back hurts, you should take it easy until the pain goes away
What is myth 4 about low back pain?
Most back pain is cause by injuries or heavy lifting
What is myth 5 about low back pain?
Back pain is usually disabling
What is myth 6 about low back pain?
Everyone with back pain should have a spine X-ray
What is myth 7 about low back pain?
Bed rest is the mainstay of therapy
What is the definition of a sprain?
damage to ligamentous tissue
What is a strain?
Damage to muscular tissue
What is a grade zero sprain?
Minimal overstretching of the ligament
What is a grade I sprain?
Microtearing
Moderate pain with tension
Visible swelling
No visible bruising
What is a grade II sprain?
Partial tearing of ligament Maximal pain with tension Visible edema Macrohermorrhage with bruising Muscle or ligament torn but still in tact
What is a grade III sprain?
Complete rupture of ligament May be painless under tension Significant edema Muscle or ligament complete rupture Joint instability
What grade is tender to palpation?
All of them
What is sciatica?
Pain in the distribution of the sciatic nerve
Nerve roots L4, L5, S1, S2, S3
What is the initial management of a strain?
Patient education Pain management Physical methods Activity alteration Work activities
How many patients recover in 4 weeks, 6 weeks and 12 weeks?
80%, 95%, 99%
How would you reassure a patient?
Tell patient there is no hint of a serious condition
A rapid recovery can be expected
If a patient has coexisting sciatica what happen to their recovery period?
Likely longer than the norm, about 12 weeks
For sufficient pain management what should be prescribed and what (based on opinion) what shouldn’t?
Non-Prescription Analgesics Are Usually Sufficient Acetaminophen (Tylenol) Ibuprofen (Motrin, Advil) Naproxen (Aleve) Avoid NSAIDs
What are some topical analgesia?
Lidocaine patch
Salicylate cream
What are some opiates used for pain management?
Tramadol (Rx) Propoxyphene (IV) Codeine (III) Hydrocodone (III) Morphine (II) Oxycodone (II) Hydromorphone (II) Meperidine (II)
What does it mean to abuse a medication?
Use of the medication for other than its intended purpose
What does it mean to be addicted to a medication?
A physiologic response of the body to the presence of a controlled substance
What is a withdrawal syndrome?
A physiologic response of the body to removal of any medication
When taking oral pain medications how long does the onset take, when does it peak and how long do they last?
Onset: 20 to 30 minutes
Peak: 1 to 2 hours
Duration: 3 to 6 hours
When taking an intramuscular injection how long does the onset take, when does it peak and how long do they last?
Onset: 20 to 30 minutes
Peak: 30 to 60 minutes
Duration: 3 to 4 hours
When taking an intravenous injection how long does the onset take, when does it peak and how long do they last?
Onset: 10-15 seconds
Peak: 15 to 30 minutes
Duration: 1 to 2 hours
What are muscle relaxants designed for?
For use as an Adjunct to Bedrest for Acute Muscular Injury
Is there an advantage to usinng muscle relaxants with NSAIDs?
No
What are some physical methods of pain management?
Manipulation
Traction
Physical Modalities
What is the definition of radiculopathy?
Neurologic Deficits in the distribution of a nerve root
Reflex or sensory loss and muscle weakness
What is radiculitis?
Inflammation of a nerve root
Usually patient will have radicular pain
Muscle spasm
Hyperreflexia
When is manipulation safe to use with sprain and strain injury?
In the first month of acute low back pain symptoms without radiculopathy
When is it not safe to used manipulation with a sprain and strain injury?
If the patient has has symptoms for more than 4 weeks without improvement
If there is pain with manipulation what could that indicate?
The presence of radiculopathy or radiculitis when due to degenerative disc disease
How is traction useful for low back pain
Transient relief obtained with radicular pain in some individuals otherwise mostly ineffective
