Lumbosacral Sprain and Strain I

Question 1

What are the primary reasons of adults for an office-based doctor visit?

Answer 1

1. Hypertension
2. Pregnancy care
3. Checkups, well care
4. Upper respiratory infections (colds)
5. Low-back pain
6. Depression and anxiety
7. Diabetes

Question 2

What is myth 1 about low back pain?

Answer 2

If you have a slipped disk you must have surgery

Surgeons agree about exactly who should have a surgery

Question 3

What is myth 2 about low back pain?

Answer 3

X-ray and newer imaging can always identify the cause of back pain

Question 4

What is myth 3 about low lack pain?

Answer 4

If your back hurts, you should take it easy until the pain goes away

Question 5

What is myth 4 about low back pain?

Answer 5

Most back pain is cause by injuries or heavy lifting

Question 6

What is myth 5 about low back pain?

Answer 6

Back pain is usually disabling

Question 7

What is myth 6 about low back pain?

Answer 7

Everyone with back pain should have a spine X-ray

Question 8

What is myth 7 about low back pain?

Answer 8

Bed rest is the mainstay of therapy

Question 9

What is the definition of a sprain?

Answer 9

damage to ligamentous tissue

Question 10

What is a strain?

Answer 10

Damage to muscular tissue

Question 11

What is a grade zero sprain?

Answer 11

Minimal overstretching of the ligament

Question 12

What is a grade I sprain?

Answer 12

Microtearing
Moderate pain with tension
Visible swelling
No visible bruising

Question 13

What is a grade II sprain?

Answer 13

Partial tearing of ligament
Maximal pain with tension 
Visible edema
Macrohermorrhage with bruising
Muscle or ligament torn but still in tact

Question 14

What is a grade III sprain?

Answer 14

Complete rupture of ligament 
May be painless under tension
Significant edema
Muscle or ligament complete rupture 
Joint instability

Question 15

What grade is tender to palpation?

Answer 15

All of them

Question 16

What is sciatica?

Answer 16

Pain in the distribution of the sciatic nerve

Nerve roots L4, L5, S1, S2, S3

Question 17

What is the initial management of a strain?

Answer 17

Patient education
Pain management
Physical methods
Activity alteration 
Work activities

Question 18

How many patients recover in 4 weeks, 6 weeks and 12 weeks?

Answer 18

80%, 95%, 99%

Question 19

How would you reassure a patient?

Answer 19

Tell patient there is no hint of a serious condition

A rapid recovery can be expected

Question 20

If a patient has coexisting sciatica what happen to their recovery period?

Answer 20

Likely longer than the norm, about 12 weeks

Question 21

For sufficient pain management what should be prescribed and what (based on opinion) what shouldn’t?

Answer 21

Non-Prescription Analgesics Are Usually Sufficient
Acetaminophen (Tylenol)
Ibuprofen (Motrin, Advil)
Naproxen (Aleve)
Avoid NSAIDs

Question 22

What are some topical analgesia?

Answer 22

Lidocaine patch

Salicylate cream

Question 23

What are some opiates used for pain management?

Answer 23

Tramadol (Rx)
Propoxyphene (IV)
Codeine (III)
Hydrocodone (III)
Morphine (II)
Oxycodone (II)
Hydromorphone (II)
Meperidine (II)

Question 24

What does it mean to abuse a medication?

Answer 24

Use of the medication for other than its intended purpose

Question 25

What does it mean to be addicted to a medication?

Answer 25

A physiologic response of the body to the presence of a controlled substance

Question 26

What is a withdrawal syndrome?

Answer 26

A physiologic response of the body to removal of any medication

Question 27

When taking oral pain medications how long does the onset take, when does it peak and how long do they last?

Answer 27

Onset: 20 to 30 minutes
Peak: 1 to 2 hours
Duration: 3 to 6 hours

Question 28

When taking an intramuscular injection how long does the onset take, when does it peak and how long do they last?

Answer 28

Onset: 20 to 30 minutes
Peak: 30 to 60 minutes
Duration: 3 to 4 hours

Question 29

When taking an intravenous injection how long does the onset take, when does it peak and how long do they last?

Answer 29

Onset: 10-15 seconds
Peak: 15 to 30 minutes
Duration: 1 to 2 hours

Question 30

What are muscle relaxants designed for?

Answer 30

For use as an Adjunct to Bedrest for Acute Muscular Injury

Question 31

Is there an advantage to usinng muscle relaxants with NSAIDs?

Answer 31

No

Question 32

What are some physical methods of pain management?

Answer 32

Manipulation
Traction
Physical Modalities

Question 33

What is the definition of radiculopathy?

Answer 33

Neurologic Deficits in the distribution of a nerve root

Reflex or sensory loss and muscle weakness

Question 34

What is radiculitis?

Answer 34

Inflammation of a nerve root
Usually patient will have radicular pain
Muscle spasm
Hyperreflexia

Question 35

When is manipulation safe to use with sprain and strain injury?

Answer 35

In the first month of acute low back pain symptoms without radiculopathy

Question 36

When is it not safe to used manipulation with a sprain and strain injury?

Answer 36

If the patient has has symptoms for more than 4 weeks without improvement

Question 37

If there is pain with manipulation what could that indicate?

Answer 37

The presence of radiculopathy or radiculitis when due to degenerative disc disease

Question 38

How is traction useful for low back pain

Answer 38

Transient relief obtained with radicular pain in some individuals otherwise mostly ineffective