MSRA: Back Problems Flashcards
What are the red flag symptoms for back pain?
Presentation under the age of 20 or onset over 55
Non-mechanical pain (inflammatory)
Thoracic pain
Past history of carcinoma, steroids, HIV, Immunosuppresion
Fever and weight loss
Widespread neurological symptoms or signs - ?cauda equina
What are the features of L3 nerve root compression?
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
What are the features of L4 nerve root compression?
Sensory loss over anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
What are the features of L5 nerve root compression?
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Positive sciatic nerve stretch test
Reflexes in tact
What are the features of S1 nerve root compression?
Sensory loss posterolateral aspect of leg and lateral foot
Weakness in foot plantarflexion
Reduced ankle reflex
Positive sciatic nerve stretch test
What are the NICE guidelines for the management of lower back pain?
NSAIDs are first line
Low dose codeine if NSAIDs not suitable
Do not offer paracetamol as monotherapy
What is the most common site for a prolapsed disc?
L5/S1
What are the risk factors for discitis?
Diabetes, immunosuppression, IVDU
What are the features of spinal stenosis?
Pain, worse with back extended, improved with leaning forward and rest
What are the features of cauda equina?
Back pain
Bilateral sciatica
Bladder and bowel dysfunction
Saddle anaesthesia
Which bacteria is the most common cause of discitis?
Staph aureus
(Echocardiogram needed to investigate endocarditis as source)
Which nerve is assessed during the straight leg raise test?
Sciatic nerve
Positive if pain worsens at 30-70 degrees
What are the key features of facet joint pain?
Midline tenderness on examination
What is the investigation of choice in spinal epidural abscess?
Full spine MRI
