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CP3 MDD > Neck and Back Pain > Flashcards

Neck and Back Pain Flashcards

1
Q

Common causes spinal pain - aged 15-30 (6)

A 
Prolapsed disc 
Trauma 
Fractures 
AS 
Spondylolisthesis 
Pregnancy
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2
Q

Common causes spinal pain aged 30-50 (3)

A

Degenerative
Prolapsed disc
Malig

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3
Q

Common causes spinal pain aged >50 (6)

A 
Degenerative 
OP collapse 
Pagets 
Malig
Myeloma  
Spinal stenosis
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4
Q

Red flags spinal pain (13)

A 
Age <20 or >55 
Acute onset elderly 
Constant progressive pain 
B symptoms 
Bladder/bowel Sx 
saddle anaesthesia 
Hx TB/HIV/Cancer 
Pain in thoracic spine 
Hx of significant trauma 
leg claudication
Saddle anaesthesia 
Point midline tenderness on palp (malig)
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5
Q

DDx neck pain (6)

A 
Trauma/whiplash 
Mechanical 
Cervical spondylosis 
Cervical myelopathy 
AS
Fibromyalgia
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6
Q

PS whiplash

A

Pain in neck/shoulders/arm

Headache, dizziness + memory loss

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7
Q

What is mechanical neck pain usually associated with?

A

Palpable mm spasm

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8
Q

What is cervical radiculopathy?

A

Compression of nerve roots

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9
Q

PS cervical radiculopathy

A

Aching in neck –> arm
Loss grip strength or weakness mm groups
Dermatomal sensory loss
Sharp pains shoot down arm

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10
Q

Causes cervical radiculopathy (6)

A 
Osteophyte formation in elderly 
Disc dehydration 
Poor shock absorption 
Nn root impingement 
Cord compression (myelopathy) 
Acute cervical disc prolapse
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11
Q

Clinical signs cervical radiculopathy (4)

A

Restricted neck movement
Modest weakness of mm invovled
Possible reflex loss
Dermatomes (C5-8)

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12
Q

Ix cervical radiculopathy

A

CT/MRI

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13
Q

mx cervical radiculopathy

A

Rx to neuro
NSAIDs
PT/deep heat
Immobilise spine

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14
Q

What is cervical myelopathy

A

Compression of SC

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15
Q

PS cervical myelopathy (3)

A

Loss fine motor control hands
Slow development spastic gait
No pain

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16
Q

O/E cervical myelopathy

A

UMN signs below compression - tingling, fine mm use restricted
LMN above compression

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17
Q

Which sign is positive in cervical myelopathy?

A

Hoffmans

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18
Q

What is Hoffman’s sign

A

Flicking distal phalynx –> flexion of other fingers

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19
Q

Cause Cervical myelopathy (3)

A

osteophytes
Disc degeneration
Malignancy

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20
Q

Ix Cervical myelopathy

A

XR

MRI

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21
Q

Mx cervical myelopathy

A

Decompressive surgery

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22
Q

PS simple mechanical back pain

A 
Lumboscaral pain 
Comes on when doing activity
Varies w/ posture, time 
Worse in evening 
Changes w/ position
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23
Q

O/E simple mechanical back pain

A

Palpable mm spasm

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24
Q

Mx simple mechanical back pain

A

Analgesia

Physio

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25
Q

What is a disc prolapse

A

Nucleus propulsus herniates into spinal canal

26
Q

PS disc prolapse

A

Self limiting lower back pain + spasm

27
Q

precipitant disc prolapse

A

lifting

28
Q

Which 2 spinal levels are most likely to have a disc prolapse

A

L4/5

L5/S1

29
Q

If herniation of disc is central, what condition can occur?

A

Cauda equina

30
Q

Signs of sciatica (3)

A 
Antalgic gait
Weakness thigh mm 
Straight leg raise
Pain increases when coughing 
--> bum hrs + leg (days) 
If tingling - nn root entrapment
31
Q

O/E sciatica (5)

A 
Flexed leg
Palpable mm spasm
Straight leg raise 30' --> pain 
Decr strength, sensation, reflexes 
PR + palpate bladder + saddle area to rule out cauda equina
32
Q

Conservative Mx sciatica

A

Antiinflamms + bed rest w/ knees flexed 2 w

33
Q

Medical Mx sciatica (if conservative not working after 2 w)

A 
Epidural injections (if radicular Sx)
MRI + Rx to surgery
34
Q

Surgical Mx disc prolapse

A

Microdiscectomy

35
Q

what % disc prolapses –> cauda equina

A

2%

36
Q

PS cauda equina (5)

A 
Lower back pain 
Urinary retention 
Saddle anaesthesia 
Decr anal tone 
Bilateral leg pain
37
Q

O/E cauda equina (4)

A

weakness
loss tone
spasticity
check anal sensation

38
Q

Ix cauda equina

A

post void bladder scan

emergency MRI

39
Q

Mx cauda equina

A

Surgical intervention - decompression

40
Q

Cause of lumbar canal stenosis (4)

A

Facet joint hypertrophy
Ligamentum flavum hypertrophy
Disc degeneration
OA

41
Q

PS lumbar canal stenosis (4)

A

Neurogenic claudication - aching pain in legs + back on walking
Pain recovers fairly slowly on sitting
Numbness + stiffness + weakness
Back pain for years

42
Q

Conservative Mx lumbar canal stenosis

A

Activity mod

Physio

43
Q

Surgical Mx lumbar canal stenosis

A

Laminectomy

Microdiscectomy

44
Q

Spondylolisthesis

A

1 vertebra = displaced

–> loss of antero-posterior alignment

45
Q

At what spinal level does Spondylolisthesis usually occur

A

L4/5

L5/S1

46
Q

PS Spondylolisthesis (3)

A

Intermittent backache
Increased pain w/ exercise or strain
Step on palp

47
Q

Causes Spondylolisthesis (3)

A

Spondylosis
Dysplasia of lumbosacral joints
OA

48
Q

Mx Spondylolisthesis

A

Activity mod

Spinal fusion surgery

49
Q

What is spondylosis

A

Deficiency of the pars intraarticularis of neural arch of VB

50
Q

What is facet joint dysfunction due to?

A

OA/RA

51
Q

PS facet joint dysfunction

A

Acute/chronic back pain
worsen in AM/extension or standing
NO HX LEG PAIN

52
Q

Inflammatory back pain - PS

A

Insidious onset stiffness + pain
Worse in AM
Systemic upset

53
Q

What can discitis PS after (2)

A

Surgery

Injection

54
Q

PS discitis

A

Localised pain

Increased inflammatory markers

55
Q

Mx discitis

A

Admit for IV ABx

56
Q

2’ mets to spine - 5 most common 1’ origin

A 
Lung 
Breast
Kidney
Prostate 
Thyroid
57
Q

PS spinal neoplasm

A

Progressive pain
worse at night
Pain over specific segment

58
Q

Ix for chronic back pain

A

Spinal XR (if red flags)
MRI
RBC/ESR if suspect infection/malig

59
Q

Mx of root entrapment

A 
Bed resst 2-3 days 
Lie flat if lower disc
Semi reclined in high
Analgesia + mm relaxants
Once pain ok = exercise + Rx to physio
60
Q

Who should be referred for surgeon for root entrapment (4)

A

Severe neuro signs
Pain >6-10w
Central disc
Bladder or anal sphincter involvement

CP3 MDD (13 decks)

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