Neck and Back Pain Flashcards
Common causes spinal pain - aged 15-30 (6)
Prolapsed disc Trauma Fractures AS Spondylolisthesis Pregnancy
Common causes spinal pain aged 30-50 (3)
Degenerative
Prolapsed disc
Malig
Common causes spinal pain aged >50 (6)
Degenerative OP collapse Pagets Malig Myeloma Spinal stenosis
Red flags spinal pain (13)
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)
DDx neck pain (6)
Trauma/whiplash Mechanical Cervical spondylosis Cervical myelopathy AS Fibromyalgia
PS whiplash
Pain in neck/shoulders/arm
Headache, dizziness + memory loss
What is mechanical neck pain usually associated with?
Palpable mm spasm
What is cervical radiculopathy?
Compression of nerve roots
PS cervical radiculopathy
Aching in neck –> arm
Loss grip strength or weakness mm groups
Dermatomal sensory loss
Sharp pains shoot down arm
Causes cervical radiculopathy (6)
Osteophyte formation in elderly Disc dehydration Poor shock absorption Nn root impingement Cord compression (myelopathy) Acute cervical disc prolapse
Clinical signs cervical radiculopathy (4)
Restricted neck movement
Modest weakness of mm invovled
Possible reflex loss
Dermatomes (C5-8)
Ix cervical radiculopathy
CT/MRI
mx cervical radiculopathy
Rx to neuro
NSAIDs
PT/deep heat
Immobilise spine
What is cervical myelopathy
Compression of SC
PS cervical myelopathy (3)
Loss fine motor control hands
Slow development spastic gait
No pain
O/E cervical myelopathy
UMN signs below compression - tingling, fine mm use restricted
LMN above compression
Which sign is positive in cervical myelopathy?
Hoffmans
What is Hoffman’s sign
Flicking distal phalynx –> flexion of other fingers
Cause Cervical myelopathy (3)
osteophytes
Disc degeneration
Malignancy
Ix Cervical myelopathy
XR
MRI
Mx cervical myelopathy
Decompressive surgery
PS simple mechanical back pain
Lumboscaral pain Comes on when doing activity Varies w/ posture, time Worse in evening Changes w/ position
O/E simple mechanical back pain
Palpable mm spasm
Mx simple mechanical back pain
Analgesia
Physio
What is a disc prolapse
Nucleus propulsus herniates into spinal canal
PS disc prolapse
Self limiting lower back pain + spasm
precipitant disc prolapse
lifting
Which 2 spinal levels are most likely to have a disc prolapse
L4/5
L5/S1
If herniation of disc is central, what condition can occur?
Cauda equina
Signs of sciatica (3)
Antalgic gait Weakness thigh mm Straight leg raise Pain increases when coughing --> bum hrs + leg (days) If tingling - nn root entrapment
O/E sciatica (5)
Flexed leg Palpable mm spasm Straight leg raise 30' --> pain Decr strength, sensation, reflexes PR + palpate bladder + saddle area to rule out cauda equina
Conservative Mx sciatica
Antiinflamms + bed rest w/ knees flexed 2 w
Medical Mx sciatica (if conservative not working after 2 w)
Epidural injections (if radicular Sx) MRI + Rx to surgery
Surgical Mx disc prolapse
Microdiscectomy
what % disc prolapses –> cauda equina
2%
PS cauda equina (5)
Lower back pain Urinary retention Saddle anaesthesia Decr anal tone Bilateral leg pain
O/E cauda equina (4)
weakness
loss tone
spasticity
check anal sensation
Ix cauda equina
post void bladder scan
emergency MRI
Mx cauda equina
Surgical intervention - decompression
Cause of lumbar canal stenosis (4)
Facet joint hypertrophy
Ligamentum flavum hypertrophy
Disc degeneration
OA
PS lumbar canal stenosis (4)
Neurogenic claudication - aching pain in legs + back on walking
Pain recovers fairly slowly on sitting
Numbness + stiffness + weakness
Back pain for years
Conservative Mx lumbar canal stenosis
Activity mod
Physio
Surgical Mx lumbar canal stenosis
Laminectomy
Microdiscectomy
Spondylolisthesis
1 vertebra = displaced
–> loss of antero-posterior alignment
At what spinal level does Spondylolisthesis usually occur
L4/5
L5/S1
PS Spondylolisthesis (3)
Intermittent backache
Increased pain w/ exercise or strain
Step on palp
Causes Spondylolisthesis (3)
Spondylosis
Dysplasia of lumbosacral joints
OA
Mx Spondylolisthesis
Activity mod
Spinal fusion surgery
What is spondylosis
Deficiency of the pars intraarticularis of neural arch of VB
What is facet joint dysfunction due to?
OA/RA
PS facet joint dysfunction
Acute/chronic back pain
worsen in AM/extension or standing
NO HX LEG PAIN
Inflammatory back pain - PS
Insidious onset stiffness + pain
Worse in AM
Systemic upset
What can discitis PS after (2)
Surgery
Injection
PS discitis
Localised pain
Increased inflammatory markers
Mx discitis
Admit for IV ABx
2’ mets to spine - 5 most common 1’ origin
Lung Breast Kidney Prostate Thyroid
PS spinal neoplasm
Progressive pain
worse at night
Pain over specific segment
Ix for chronic back pain
Spinal XR (if red flags)
MRI
RBC/ESR if suspect infection/malig
Mx of root entrapment
Bed resst 2-3 days Lie flat if lower disc Semi reclined in high Analgesia + mm relaxants Once pain ok = exercise + Rx to physio
Who should be referred for surgeon for root entrapment (4)
Severe neuro signs
Pain >6-10w
Central disc
Bladder or anal sphincter involvement
