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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
What is a disc prolapse
Nucleus propulsus herniates into spinal canal
26
PS disc prolapse
Self limiting lower back pain + spasm
27
precipitant disc prolapse
lifting
28
Which 2 spinal levels are most likely to have a disc prolapse
L4/5 | L5/S1
29
If herniation of disc is central, what condition can occur?
Cauda equina
30
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 ```
31
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 ```
32
Conservative Mx sciatica
Antiinflamms + bed rest w/ knees flexed 2 w
33
Medical Mx sciatica (if conservative not working after 2 w)
``` Epidural injections (if radicular Sx) MRI + Rx to surgery ```
34
Surgical Mx disc prolapse
Microdiscectomy
35
what % disc prolapses --> cauda equina
2%
36
PS cauda equina (5)
``` Lower back pain Urinary retention Saddle anaesthesia Decr anal tone Bilateral leg pain ```
37
O/E cauda equina (4)
weakness loss tone spasticity check anal sensation
38
Ix cauda equina
post void bladder scan | emergency MRI
39
Mx cauda equina
Surgical intervention - decompression
40
Cause of lumbar canal stenosis (4)
Facet joint hypertrophy Ligamentum flavum hypertrophy Disc degeneration OA
41
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
42
Conservative Mx lumbar canal stenosis
Activity mod | Physio
43
Surgical Mx lumbar canal stenosis
Laminectomy | Microdiscectomy
44
Spondylolisthesis
1 vertebra = displaced | --> loss of antero-posterior alignment
45
At what spinal level does Spondylolisthesis usually occur
L4/5 | L5/S1
46
PS Spondylolisthesis (3)
Intermittent backache Increased pain w/ exercise or strain Step on palp
47
Causes Spondylolisthesis (3)
Spondylosis Dysplasia of lumbosacral joints OA
48
Mx Spondylolisthesis
Activity mod | Spinal fusion surgery
49
What is spondylosis
Deficiency of the pars intraarticularis of neural arch of VB
50
What is facet joint dysfunction due to?
OA/RA
51
PS facet joint dysfunction
Acute/chronic back pain worsen in AM/extension or standing NO HX LEG PAIN
52
Inflammatory back pain - PS
Insidious onset stiffness + pain Worse in AM Systemic upset
53
What can discitis PS after (2)
Surgery | Injection
54
PS discitis
Localised pain | Increased inflammatory markers
55
Mx discitis
Admit for IV ABx
56
2' mets to spine - 5 most common 1' origin
``` Lung Breast Kidney Prostate Thyroid ```
57
PS spinal neoplasm
Progressive pain worse at night Pain over specific segment
58
Ix for chronic back pain
Spinal XR (if red flags) MRI RBC/ESR if suspect infection/malig
59
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 ```
60
Who should be referred for surgeon for root entrapment (4)
Severe neuro signs Pain >6-10w Central disc Bladder or anal sphincter involvement

CP3 MDD (13 decks)

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