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MDD > Neck and Back Pain > Flashcards

Neck and Back Pain Flashcards

1
Q

what are the differentials for neck pain

A

Trauma

Mechanical Pain

Brachial neuralgia/Cervical Root pathology

Cervical Spondylosis

Cervical Myelopathy

Ankylosing Spondylitis

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2
Q

what kind of forces commonly cause neck pain

A

acceleration/deceleration forces e.g. car crash

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3
Q

how does whiplash present

A

pain in neck/shoulder
dizziness
headache
memory loss

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4
Q

how long does it take whiplash to settle

A

months

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5
Q

how does a cervical radiulopathy present

A

‘aching pains’ down arm

Progressive loss of pinch grip

Dermatomal sensory loss

May be occasional shooting pains down the arm – reproducible with spurlings test (turn patients head to affected side and presses down on the top of the head (as if you’re trying to compress the spine vertically))

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6
Q

what is the most common cause of cervical radiculopathy in the older population

A

osteophytes

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7
Q

what is found on examination for cervical radiculopathies

A

UMN signs below the level of compression

LMN signs at the level of compression

For example a C5/6 lesion leads to wasting and fasciculation of the deltoids + biceps with hyporeflexia, but hyperreflexive triceps and spastic legs with upgoing plantars

+ve Hoffmans sign
Abrupt force on the middle fingernail (e.g. flicking it) causes flexion in the thumb/index finger
UMN sign

Positive Spurlings test

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8
Q

what are differential causes for cervical radiculopathy

A

osteophytes
Cervical Malignancy
Disc Degeneration

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9
Q

what are life threatening causes of back pain that must be ruled out

A

AAA

Aortic Dissection

Pancreatiits

MI

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10
Q

what are red flags for back pain

A

<20, >55

Constant or progressive pain

Night pains

B symptoms

Bladder/bowel symptoms

History of TB/HIV/malignancy

Thoracic spine pain

History of significant trauma

Saddle anaesthesia

Point tenderness in midline

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11
Q

what are features of simple mechanical back pain

A

Usually lumbosacral region

20-55 years old

Normally a fixed point in which the pain started, usually with some form of bending with a load, twisting etc

Buttock/thigh pain may be referred

Palpable muscle spasm on exam

Diagnosis of exclusion

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12
Q

whats the management of mechanical back pain

A

Analgesia

Keep active

Physio exercises

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13
Q

whats the prognosis of simple mechanical back pain

A

90% recover within 6 weeks

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14
Q

what age ranges most commonly get lumbar disc prolapse

A

30-50

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15
Q

what region commonly is affected for lumbar disc prolapse

A

L4/5, L5/S1

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16
Q

when does a herniated disc cause cauda equina syndrome

A

if the herniation is central

17
Q

what are some features of cauda equina syndrome

A

Triggering event leads to patient seizing up + unable to straighten back

Pain worse on coughing/straining

Pain moves into buttock within hours and into the leg within a day or 2

Radicular pain also present

Severe lancinating (stabbing) pains/paraesthesia in one leg

Rarely in both

Associated clumsiness of the foot

Associated bladder/bowel problems
Incontinence
Retention

18
Q

what intervention is required in cauda equina syndrome

A

Emergency MRI/urgent surgical intervention required to prevent long term bladder/bowel/reproductive sequele

19
Q

what may you find on examination in cauda equina syndrome

A

Patient may walk with a flexed leg or with obvious scoliosis

On spinal examination there may be scoliosis and palpable muscle spasms

Straight leg raise to 30 degrees produces pain

Contralateral also causing pain = bad sign, indicates a very large lesion

Pain in anterior thigh on femoral stretch test also suggests upper disc prolapse

Neurological exam shows muscle weakness, loss of sensation and diminished reflexes at the affected level

20
Q

what focal signs are prominent on cauda equina at L4

A

Muscle weakness, loss of sensation and diminished reflexes at the affected level

Most commonly extensor hallucis longis and tibialis anterior, extension of big to, dorsiflexion of foot

21
Q

what focal signs are prominent on cauda equina at L5

A

muscle weakness, loss of sensation and diminished reflexes at the affected level

Peroneus brevis and longus may also be affected along with foot eversion

22
Q

what focal signs are prominent on cauda equina at S1/2

A

muscle weakness, loss of sensation and diminished reflexes at the affected level

Gastrocnemius and soleus are affected in lower lesions along with plantar flexion

23
Q

what examinations are required if you think cauda equina syndrome is happening

A

PR – no sensation/anal tone

Palpate bladder for retention

Retention will be painless

Check sensation of saddle area

24
Q

whats the management of suspected disc herniation

A

Conservative management
NSAIDS
Bed rest with knee slightly flexed
Reduces herniation in more than 90%

Symptoms >2 weeks  
Regular epidural injections to treat radiculopathy  
MRI/surgical referral  
Single level disease = microdiscectomy  
Removal of herniating material  
Rehab essential
25
Q

what are common causes of lumbar canal stenosis

A

OA

Disc degeneration

Facet joint hypertrophy

Ligamentum flavum hypertrophy

26
Q

what are some symptoms of lumbar canal stenosis

A

Aching pains in legs when walking

Pain recovers on sitting/bending forwards

Numbness/weakness/stiffness in legs

Symptoms variable

27
Q

whats the management of lumbar canal stenosis

A

Conservative
Activity modification
Physio

Surgical
Laminectomy
OA-related pain remains

28
Q

what is spondylolithesis

A

one vertebra is displaced on the vertebra below, anteriorly or posteriorly

29
Q

what vertebrae is usually affected in spondylolithesis

A

L4/5 or L5/S1

30
Q

what is the presentation of spondylolithesis

A

Intermittent backache

Worse with activity

31
Q

what do you expect to find on examination in spondylolisthesis

A

a step on spinal examination

32
Q

what are common causes of spondylolithesis

A

most commonly - stress fracture on the lumbar pars articularis

dysplasia of lumbar facet joints

OA of facet joints

33
Q

what are risk factors for OA of facet joints

A

old age

extreme athletes

34
Q

whats the management for spondylolithesis

A

Conservatively, as for mechanical back pain

If symptoms are severe or patient is young, spinal fusion can be performed

35
Q

what are common causes of non-mechanical back pain

A

Inflammatory

Infective - discitis

Metabolic - osteoporosis , pagets, hyperparathyroidism

Neoplastic - mets, myeloma

36
Q

what are some features of facet joint dysfunction

A

Highly common cause of lower back pain

OA/RA may be cause, but commonly its minor trauma

Leading to acute or chronic back pain, worse on standing, extension of the back or in the morning

No history of pain In the legs

May be local tenderness over facets

MDD (22 decks)

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