MSK: Part 6 Flashcards
Why do we need to be precautioned with Mechanical Lower Back pain
- Very common
2. Sinister causes of backspin include malignancy, infection or inflammatory causes
What are the red flags for serious lower back pain/spinal pathology
- Age of onset less than 20 or greater than 55
- Violent trauma (car accident)
- Constant, progressive, non-mechanical pain
- Thoracic pain
- Systemic steroids, drug abuse or HIV
- Systemically unwell, weight loss
- Persisting severe restriction of lumbar flexion
- Widespread neurology
- Structural deformity
What activities can cause common back pain
- Stooping
- Twisting whilst lifting
- Exposure to whole body vibration
- Psychosocial distress
- Smoking
- Dissatisfaction with work
Main causes of back pain
- Lumbar disc prolapse
- Osteoarthritis
- Fractures
- Spondylolisthesis
- Heavy manual handling
- Stooping and twisting whilst lifting
- Exposure to whole body vibration
Risk factors for back pain
- Smoking
- Work
- FEMALE (recurrent)
- AGE (recurrent)
- Pre-existing chronic widespread pain - fibromyalgia (recurrent)
- Psychosocial factors
Clinical presentation for back pain
- Back is stiff and a scoliosis (where spine twists and curves to the side) may be present when patient is standing
- Muscular spasm is visible and palpable + causes local pain and tenderness
- Pain is unilateral
- Episodes are short-lived and self-limiting
- Sudden onset
- Morning stiffness is absent
- Excersise aggravates pain
What structures can be a source of lower back pain
- Spinal movement occurs at the disc and posterior facet joints - stability achieved by spinal ligaments and muscles
Where do lesions in lumbar spondylosis occur
Intervertebral disc
Role of the intervertebral disc
Rotation and bending of spine
Describe the structure of an intervertebral disc
Fibrous structure whose tough capsule inserts into the rime of the adjacent vertebra
At what age do changes in the disc start to happen in lumbar spondylosis
- Teenage years or early twenties and increases in age
What happens to the inner gel layer of the intervertebral disc
Gel changes chemically, breaks up, shrinks and loses its compliance
What happens to the surrounding fibrous zone of the intervertebral disc
Develops circumferential issues
Clinical presentation of Lumbar spondylosis
Initially asymptomatic but visible on MRI as decreased hydration
Later - discs become thinner and less compliant
How does the changes in the intervertebral disc effect the intervertebral ligaments
Causes circumferential bulging
What happen in the adjacent vertebra of lumbar spondylosis
Reactive changes develop: bone becomes sclerotic and osteophytes form around the rim of the vertebra
What are the most common sites for lumbar spondylosis
L5/S1 and L4/L5
What is seen in young people with lumbar spondylosis
- Disc prolapse through adjacent vertebral end-plate produces SCHMORL’s NODE on X-ray
Consequence of Schmrol’s node
Painless but accelerates disc degeneration
What can lumbar spondylosis cause if not asymptomatic
- Episodic spinal pain
- Progressive spinal stiffening
- Facet joint pain
- Acute disc prolapse, with or without nerve too irritation
- Spinal stenosis
What syndrome is caused by lumbar spondylosis
- Secondary osteoarthritis of misaligned facet joints
When is pain in facet joints worse
Bending backwards and when straightening from flexion
Where is pain felt in facet joint syndrome
Lumbar
Uni or bilateral and radiates to the buttocks
Diagnosis of facet joint syndrome
MRI - shows facet joints and osteoarthritis, an effusion or ganglion cyst