MSK & Lower Back Flashcards
1
Q
Cauda equina
- S&S
- Management
A
S&S
- Spine/leg pain
- Peri-anal numbness
- Bladder/bowel dysfunction (eg. cannot hold midstream)
Mx
- Emergency surgery
- Decompressive laminectomy - VTE prophylaxis
- Supportive therapy
2
Q
Metastatic Spinal Cord Compression (MSCC)
- S&S
- Mx
A
- Back pain
Paraesthesia
Bladder/bowel loss of tone
Hyper reflexia - Refer for surgery
3
Q
Spinal infection
- S&S
- Mx
A
- Fever
Weakness/paralysis
Spinal pain
Meningism - Abx + Sepsis 6
4
Q
Septic arthritis
1. S&S
- Mx
A
- Warm, red joint
Very painful
Febrile
Loss of function - Urgent ortho referral
(Washout and ABx)
5
Q
Cervical Spondylitic Myelopathy (CSM)
- S&S
- Mx
A
CSM
- Paraesthesia and weakness
- Imbalance
- Pain and neck stiffness
Mx
- Hard cervical collar
- mild - moderate disease - Surgical decompression
- moderate to severe
- fusion or immobilisation
6
Q
Cauda equina
- Red flags
A
Cauda equina
- Perineal numbness
- Inability to stop urinating mid-stream
- DRE: Cannot ‘bear down’
7
Q
Back pain
- Red flag differentials
A
Back pain red flag DDx
- Cauda equina
- Bowel/bladder
- Sciatica and saddle - Metastatic SCC
- Sensory loss
- Hemiplegia/paresis
- Paraplegia/paresis
- Autonomic - Trauma
- High energy
- Midline tenderness
- GCS - Epidural abscess
- DM
- IVDU
- Relieved by rest - Acute pancreatitis
- Mid-epigastric/LUQ
- Relieved leaning forward
- Gallstones/ETOH hx
6. AAA Triad: - Abdo/back pain - Pulsatile mass - Hypotension
8
Q
MSK back pain
- 5 Eliminations
A
MSK back eliminations
- Neurological
- Neoplastic
- Inflammatory
- Fracture
- Referred
9
Q
MSK Back Pain
- Classfication
A
MSK Back Pain
- Acute
- Sub-acute
- Chronic
10
Q
MSK Back Pain
- S&S
A
MSK Back S&S
- Obesity or poor posture
- Prior or FHx
- Stress and psychiatric
- Radiation
- Not beyond knee - No red flags
- No Fs
- Fever
- Fluctuance
- Freak on palpation - Pain Character
- Dull, gnawing, tearing, burning, spasming
11
Q
MSK Back Pain
- Acute/SA Mx
A
Acute/SA MSK back Mx
- Education and resume
- Temperature treatment
- Heat/Ice - Physiotherapy
- Massage/acupuncture
- Lumbar spinal manipulation
- Analgesia
- NSAID
- Paracetamol
- Weak opioid - Muscle relaxant
- Cyclobenzaprine
- Tizanidine
- Metaxalone
- Diazepam
12
Q
Opioid
- Potencies
- Duration
A
Opioids
- Codeine 0.1x
Dihydrocodeine 0.1x
- 3-6 - Hydrocodone 0.66x
- 4-8 - Morphine 1.0x
- Oxycodone 1.5x
- 3-4 - Hydromorphone 5x
- 4-5 - Methadone 5x
- 8-12 - Buprenorphine SL 80x
- 6-8
Buprenorphine TD 100x
- 72-168
- Fentanyl TD 100x
- 72
13
Q
MSK Back pain
- Chronic mx
A
Chronic back pain mx
- Exercise and physio
- Yoga/pilates/massage - Pharmacotherapy
- NSAID
- Opiates - Thermal annular procedures
- Surgery
- Rarely advised
14
Q
Osteoporosis
- S&S
A
Osteoporosis S&S
- Old/thin/white/female
- Back pain
- Kyphosis
- Fragility fractures
15
Q
Bursitis
- S&S
A
Bursitis S&S
- Pain at site
- Active RoM Loss
- RFs
- Mechanical stress eg. occupation
- Abnormal gait
- Autoimmune - Swelling