MS 4 Flashcards
LBP
1/5 people affected, most cases resolve w/o intervention within several weeks
LBP - consider what
5
- trauma
- infection
- malignancy
- psychosocial factors
- comorbid conditions
LBP - red flag symptoms
3
- significant trauma
- neurologic complaints - deficits, bladder or bowel dysfunction, saddle anesthesia, loss of rectal tone, sexual dysfunction
- history - malignancy, current/recent IV drug use, recent back sx or procedure, fever associated w/ back pain, unintentional weight loss
LBP physical exam - evaluate for underlying what
conditions and neuro deficits as well as causes of back pain not r/t the spine i.e. renal colic, aortic dissection
LBP PE - MS
2
- exam is typically unremarkable
- may be associated w/ paraspinal muscle strain/spasm
LBP PE - radiculopathy/sciatica
3
- pain radiating to lower extremity, usually unilateral
- weakness
- sensory changes along spinal nerve root distrubtion
LBP PE - cauda equina syndrome
5
- decreased perineal sensation
- +/- diminished rectal tone
- lower extremity reflexes diminished
- bladder/bowel dysfunction
- great toe dorsiflex diminished
LBP PE - epidural abscess
3
- fever
- neuro deficits
- percussive tenderness of the spine
LBP - img/testing
none usually needed except in the presence of red flag sx
LBP - x rays when
setting of trauma
nonspecific LBP - non pharm tx
6
- prognosis is usually favorable
- advise pts to remain active, avoid bed rest
- heating pads
- yoga
- massage
- PT
nonspecific LBP - pharm tx
4
- NSAIDs
- tylenol
- muscle relaxors
- steroids not typically rec
nonspec LBP - f/u
in 4 weeks or sooner if persistent/worsening sx; refer to PCP for minor injuries/symptoms and f/u care
nursemaid’s elbow
subluxation of the radial head d/t a tear of annular ligament
subluxation of the radial head d/t a tear of annular ligament
nursemaid’s elbow
nursemaid’s elbow - most common in what area
upper extremity injury in children younger than 6 years old
nursemaid’s elbow - peak age
2-3 years old; can occur as young as 6 months
nursemaid’s elbow - predilection for who
girls and left arm
nursemaid’s elbow - caregiver reports a history of
pulling up, swinging child, or a fall on an outstretched hand followed by pain and child refusing to use the affected arm
nursemaid’s elbow -child might c/o
pain at the elbow or wrist or may not complain of pain at all
nursemaid’s elbow - physical exam findings
4
- affected arm held against the body w/ elbow slightly flexed and arm pronated
- refusal to move arm
- might have mild tenderness to palpation of radial head
- examine entire arm for additional injury
nursemaid’s elbow - PE findings should be free of what symptoms
4
- swelling
- erythema
- ecchymosis
- deformity to the elbow and forearm
nursemaid’s elbow - x ray typically not needed unless
4
- hx inconsistent w/ the mechanism to cause nursemaid’s elbow
- physical exam shows overt signs of trauma, swelling, bruising, or significant point tenderness
- concern for fx on exma
- reduction is unsuccessful after 2 attempts AND child is not using affected arm after 30 minutes
nursemaid’s elbow - when should child’s arm be working
5-30 mins after reduction
