MSK - Lower Back Pain

Question 1

what is/are the likely diagnosis/es for LBP:

• chronic onset
• pain on standing/sitting
• worse on exercise, relieved by rest/lying flat
• often triggered by innocuous activity

Answer 1

1. non-specific LBP
2. mechanical pain +/- lumbar muscle spasm or sprain
3. OA

Question 2

what are the risk factors for non-specific LBP?

Answer 2

1. overweight
2. physical inactivity
3. occupational factors, e.g. heavy lifting
4. depression and other psychological conditions

Question 3

30 yo male pt presents with:

• progressive back pain and stiffness (5 mth Hx)
• worse in morning, relieved by exercise

What is likely Dx?

What if also had Hx of psoriasis?

What if also presented with visual disturbance and urinary stymptoms?

Answer 3

1. ankylosing spondlyitis
2. psoriatic arthritis
3. reactive arthritis

Question 4

what are the red flag Sx for CES?

Answer 4

• saddle anaesthesia or paraesthesia
• recent onset bladder dyfunction
• recent onset faecal incontinence
• perineal/perianal sensory loss
• laxity of anal sphincter
• severe or progressive neurological deficit in lower extremities

Question 5

what are the red flag Sx for spinal fracture?

Answer 5

• sudden onset of severe central pain in spine, relieved by lying down
• Hx major trauma or minor trauma/strenuous lifting in pts with osteoporosis
• point tenderness over vertebral body

Question 6

what are the red flag Sx for vertebral cancer ?

Answer 6

• pain that remains when lying down, aching night-time pain that disturbs sleep
• onset in >50 yrs or <20 yrs
• Hx of cancer
• constitutional Sx, e.g. fever, fatigue or unexplained weight loss
• point tenderness over vertebral body

Question 7

what are the red flag Sx for vertebral infection?

Answer 7

• features of infection
• pain that remains when lying down, aching night-time pain that disturbs sleep
• point tenderness over vertebral body
• recent bacterial infection. e.g. UTI, IV drug use or immune suppression
• structural deformity of spine, e.g. scoliosis