Multiprofessional Back Pain 17/10/18 Flashcards
What do patient’s present to their GP with?
Pain -Localised -Lumbar Referred pain -Sciatica Stiffness Loss of sleep Loss of function -Walking -Lifting -Carrying Affecting ability to work
What type of pain can refer down the front of the leg?
Femoral
What are important parts of the history for back pain?
Pain -Type -Radiation -Localised Loss of function Trauma - recent/past Previous surgery Symptoms suggesting other pathology -Urinary tract -GI -Respiratory -Systemic illness
What parts of the Look physical examination are important?
How the patient walks in and out
Deformity e.g. scoliosis, kyphosis, scars
What parts of the feel physical examination are important?
Spinal tenderness
Paravertebral muscles
Get the patient to show you where
What parts of the move physical examination are important?
Flexion Extension Lateral flexion SLR Tone Power Reflexes Sensation in legs
What investigations are done for back pain?
Usually none Systemic? - ESR/PV/Calcium/Alk Phos Rarely X-ray MRI Often not what you see is what you get
Is imaging required for non-specific lower back pain?
No
Is imaging required for specific lower back pain?
Yes
What imaging is done for specific back pain with red flags, significant trauma or known osteoporosis?
Lumbar spine X-ray
may be considerred
What imaging is done for sciatica >4weeks or spinal claudication?
MRI
What are red flag imaging referral examples?
Known cancer
Significant trauma
Persistent fever >48 hours
Significant weight loss (>10% in 3 months)
Why is MRI superior to X-ray?
Most back pain is due to soft tissue damage
X-ray does not show soft tissue where as MRI does
Can sciatica resolve spontaneously?
Yes
Is MRI specific?
Lots of patients with no symptoms will have disc problems on MRI
No
