MSK Medicine Flashcards
Define lower chronic back pain
More than 3 months
Define acute lower back pain
Less than 3 weeks.
Name a cause of Lower back pain
Mechanical back pain, INV disc herniation, sciatica, ankolysing spondolithesis, cauda equina.
Name two RFs for lower back pain
Obesity, sedentary lifestyle causing weakness of paraspinal muscles, poor posture, poorly designed seating, incorrect manual handling, age, vibrations from driving or operating machinery, excessive exercise.
What scoring tool is used for guiding management for lower back pain?
Keele STarT Back Screening Tool
How does mechanical back pain present?
Worse when spine is loaded. Relieved by rest.
How is mechanical back pain managed?
Self management, improve manual handling technique, improve posture, ensure good seating when sitting at desk. Exercise programme and physiotherapy.
How does a slipped disc present?
Depends on whether L4/5, L5/S1. Lower back pain, numbness and tingling, difficulty straightening back, muscle weakness.
What would your first line investigation be for suspected slipped disc?
MRI scan.
How is slipped disc managed?
Keep active, analgesia, steroid injection, physio, lumbar decompression surgery.
Describe the presentation of sciatica
Unilateral leg pain, lower back pain, parasthesia, muscle weakness.
What investigation would you do for suspected sciatica?
Positive straight leg raising test - raise leg when lying on back - this increases pain.
How is sciatica managed?
Self exercises, physio, analgesia - NSAIDs, paracetamol, codeine. NEED to rule out red flags and safety net.
How does ankolysing spondylitis present?
Chronic back pain and stiffness. Suggestive of inflammatory cause - e.g. worse in morning, improves with movement. Fatigue. Patient less than 45years.
What investigations would you do for suspected ankylosing spondylitis?
XRAY - sacroilitis, blood test for HLA-B27.
Define spinal stenosis
Abnormal narrowing of the spinal canal, which can result in compression of the spinal cord or nerve roots.
How does spinal stenosis present?
Elderly due to degenerative changes, discomfort when standing, pain in LL, bilateral symptoms in 70% of cases, numbness, neurogenic claudication.
What investigation would you do for suspected spinal stenosis?
MRI referral
What management would you advise for spinal stenosis?
Analgesia, exercise, weight loss and surgery.
Define spondyloithesis
Anterior displacement of the vertebra above relative to the vertebra below.
How does spondyloithesis present?
Very varied - asymptomatic, occasional lower back pain, sciatica, neurogenic claudication
What is seen on XRAY for spondyloithesis?
Scotty dog sign.
Define cauda equina
Compression of nerve roots in the cauda equina.
What are red flags for CES?
Bilateral sciatica, bilateral neurological deficit, urinary retention or incontinence, faecal incontinence, perianal numbness, erectile dysfunction.