Mechanical Back Pain Flashcards
Dr J Maclean
what are the causes of backspin?
viscerogenic spondylogenic discogenic neurogenic psychogenic
name a viscerogenic cause of backpain.
AAA peptic ulcer gallbladder kidney liver etc
what are the 3 things present in a back history?
back pain
leg pain
neurological symptoms
what are the 3 clinical presentations of back pain?
PSP - possible spinal pathology
NRP - nerve root problems
MBP - mechanical back pain
Where is the common location of back pain?
lumbar/thoracic region
what types of onset of back pain are there?
sudden
gradual
insidious
what is the natures of back pain?
sharp
shooting
dull
leg pain can either be ________ or ____
referred or root
what type of pain is referred leg pan?
dull
buttock/thigh
rare below knee
ill definied
what type of pain is root leg pan?
sharp/shooting/electric
below knee to ankle
anatomical sensory
SCIATICA
what are the neurological symptoms in back pain?
bowel/urinary
incontinence
loss of control
perianal - saddle anaesthesia
bilateral or unilateral
what additional information is useful in the history?
age and occupation
litigation
what are the red flags in back pain?
systemic upset
saddle anaesthesia +/- bladder or bowel upset
name some possible spinal pathologies (4)
osteoporosis in spine causing fracture
tumours - metastatic
infection
inflammatory - ankylosing spondylitis
what are the 5 cancers that spread to bone?
breast bronchus prostate thyroid kidney (adenocarcinoma of lung)
what are the causes of nerve root problems in back pain?
disc prolapse
what is the pathogenesis of disc prolapse?
impaired disc nutrition
disc prone to damage
disc fissure
protrusion, extrusion, sequestrated
either small or large vertebral canal
loss of disc height
facet arthropathy
back pain (+/- canal stenosis)
what are the 2 types of vertebral canal?
large and small
outline the large vertebral canal
back pain from stretched annulus/post long ligament
outline the small vertebral canal
root compression
inflammatory mediators
root pain and tension signs
resolution/surgery
when do you diagnose mechanical back pain?
diagnosis of exclusion
most common
Paris interacularis looks like what on x-ray?
scotty dog
name the myotomes in:
hip flexion
knee extension
foot dorsiflexion & EHL
ankle plantarflexion
hip flexion - L1/2
knee extension - L3/4
foot dorsiflexion & EHL - L5
ankle plantarflexion - S1/2
what must you not forget to examine in someone with back ache?
abdominal exam and PR
what does the schober’s method measure?
spinal flexion
