Neck and back pain Flashcards
What are the common causes of neck and back pain aged 15-30 years?
prolapsed disc trauma fractures ankylosing spondylitis spondylolisthesis pregnancy
What are the common causes of neck and back pain aged 30-50 years?
degenerative spinal disease
prolapsed disc
malignancy (primary or secondary)
Which cancers can cause bony mets to the spine?
lung breast prostate thyroid kidney
What are the common causes of neck and back pain aged >50 years?
degenerative osteoporotic vertebral collapse paget's disease malignancy myeloma spinal stenosis
What are the red flag symptoms for spinal pain?
aged <20 or >55 acute onset in elderly people constant or progressive pain nocturnal pain worse pain on being supine fever, night sweats, weight loss history of malignancy abdominal mass thoracic back pain morning stiffness bilateral or alternating leg pain neurological disturbance sphincter disturbance current or recurrent infection immunosuppression leg claudification or exercise related leg weakness/numbness (spinal stenosis)
What investigations should be carried out if you suspect a specific cause or if there are red flag symptoms?
FBC, ESR and CRP (myeloma, infection, tumour), U&Es, ALP, PSA
Serum/urine electrophoresis (myeloma)
X-rays: can exclude bony abnormalities but aren’t generally indicated
MRI - can detect disc prolapse, cord compression, cancer, infection or inflammation e.g. sacroiliitis
What are the differentials for neck pain?
trauma mechanical or muscular neck pain whiplash injury disc prolapse and nerve root entrapment ankylosing spondylitis polymyalgia rheuamtica fibromyalgia chronic (work related) upper limb pain syndrome tumour shoulder lesions
What is torticollis?
pain is mechanical/muscular in origin
How does muscular neck pain present?
- following injury, falling asleep in awkward position
- unilateral or bilateral neck pain
- chronic burning pain (anxiety/stress)
- palpable muscle spasm which may lead to abnormal posture
- affects the trapezius, C7 spinal process and paracervical musculature
- associated with tension headache (seen in fibromyalgia)
Which injuries cause nerve root entrapment?
Acute cervical disc prolapse
pressure on the root from the spondylotic osteophytes narrowing the root canal
How does nerve root entrapment present?
Unilateral pain in the neck, radiating to inter scapular and shoulder regions
Diffuse aching pain is followed by sudden pain down the arm, in the nerve root distribution, with pins and needle s, numbness, weakness and loss of reflexes
What causes whiplash injuries?
Usually presents to A&E and GP
Due to acceleration-deceleration forces applied to the neck, usually in a RTA when the person is wearing a seatbelt is struck from behind
How do whiplash injuries present?
complex pattern of pain in the neck, shoulder and arm
Headache, dizziness, less of memory and poor concentration may occur
Takes weeks-months to settle
Radiography is reserved for those with brain injury - there is low probability with no cervical tenderness or focal neurological deficit and normal alertness
What is the most common cause of back pain?
Mechanical back pain (over 90%)
What is the general presentation of mechanical back pain?
long
starts suddenly and may be recurrent is helped by rest is often precipitated by an injury may be unilateral or bilateral patients may be systemically unwell pain is limited to back and upper legs
What is seen on examination in mechanical back pain?
the back is stiff and scoliosis may be present when the patient is standing
muscular spasm is visible and palpable and causes local pain and tenderness
it lessens when sitting or standing
What are the causes of mechanical back pain?
trauma muscular and ligamentous pain fibrositic nodulosis postural back pain lumbar spondylosis facet joint syndrome lumbar disc prolapse spinal and root canal stenosis spondylosis/spondyloisthesis disseminated idiopathic skeletal hyperostosis fibromyalgia
How should you assess a patient with back pain caused by trauma?
look for a specific causative movement
check no damage to surrounding structures, particularly nerve/nerve root entrapment or any damage to blood vessels
check that the trauma would have actually caused the injury (think osteoporosis/malignancy)
How is muscular or ligament back pain managed?
send to physio
What is fibrositic nodulosis?
tender nodules in the upper buttock along the iliac crest
probably traumatic
lower back pain
How is fibrositic nodulosis managed?
intralesional corticosteroid injections
Which patients commonly get postural back pain?
common in individuals who sit in supportive chairs, obese individuals, patients with muscular weakness or in pregnancy
How is postural back pain managed?
NSAIDs and analgesics
exercises
weight control
What is lumbar spondylosis?
intervertebral disc gel like inner zone changes chemically, breaks up and shrinks and loses compliance
starts in late teens/20s
surrounding vertebrae become sclerotic and ostephytes from around the rim of the vertebra
What are the symptoms of lumber spondylosis?
may be symptomless episodic mechanical back pain facet joint pain acute disc prolapse +/- nerve root irritation spinal stenosis spondylolisthesis
What is facet joint syndrome?
secondary osteoarthritis of the facet joints due to lumbar spondylosis
Pain is worse on bending forward or straightening from flexion, can radiate to buttocks
What do the facet joints show on MRI?
osteoarthritis, effusion, ganglion
How is facet joint syndrome treated?
physiotherapy
weight loss
corticosteroid injection
