Neck And Back Pain Part 1

Question 1

What is the mnemonic for the ddx for neck and back pain ?

Answer 1

I MDT
Inflammatory 
Infective 
Mechanical pain 
Degenerative 
Trauma

Question 2

What is the differentials for Neck Pain ? 😭

Answer 2

Inflammatory: ankylosing Spondylosis 
Infective: Discitis 
Mechanical neck pain 
Degenerative: Cervical spondylosis/myelopathy/Radiculopathy + Malignancy 
Trauma: Whiplash and Cervical Fracture

Question 3

What is the differentials for Back Pain ? 😭

Answer 3

Inflammatory: Ak + seronegative spondylopathies
infective: TB/Discitis
Mechanical Back pain
Degenerative: Cauda Equina and Malignancy: (bone mets + myeloma)
Trauma: osteoporotic crush fracture, Paget’s disease and Hyperparathyroidism

Question 4

What are the other causes of BacK pain with regards to the Ff:

• non-spinal causes (3)
• neurological causes (4)? 😭

Answer 4

• Non spinal and serious causes (3): AAA, dissecting Aortic aneurysm and pancreatitis
• Neurologacl causes (4): 3SL sciatica, spondylolysis , spondylolisthesis and lumbar canal stenosis

Question 5

What is the mnemonic for Red flags of Back pain ?

Answer 5

BACK PAIN

Question 6

State the red flags of BACK PAIN 😭

Answer 6

Bladder/Bowel dysfunction + B symptoms (NWF, fatigue)
Age <20 or >55 years old
Constant or progressive back pain + nocturnal pain
Kick leg: Bilateral or alternating leg pain

Pain in the thoracic spine
A Hx of TB/HIV/Malignancy
IVDUs
Neourological: saddle anaesthesia

Question 7

What is the history for Back pain and mnemonic for associated symptoms ?

Answer 7

O SOCRATES + 3PS

Associated symptoms: SSRLs

Question 8

Describe the symptoms simple mechanical power back pain (4)

Answer 8

Age 20-55

1. Sudden/spontaneous onset of mild back pain
2. Pain may be referred to buttocks/thigh
3. Pain worse with movement and eased by rest
4. . History of mild trauma/heavy lifting

Question 9

What do you find on examination for mechanical Back pain (1) ?

Answer 9

Palpable muscle spasms leading to local tenderness

Question 10

What is the treatment of simple mechanical Back pain ?

Answer 10

1. Simple analgesia + keep active with normal physical activity
2. Physiotherapy

Question 11

What is SCIATICA ?

Answer 11

Lumbar Radiculopathy which may occur due to acute lumbar disc prolapse peripherally or compression/entrapment of sciatic nerve)

Question 12

What are the symptoms of sciatica ?

Answer 12

Lower back pain + unilateral leg pain/numbness radiating to below the knee to foot/toes (can be bilateral/rare)
-Triggering event known

Question 13

What are the 2 examination findings ?

Answer 13

Femoral stretch test and Straight leg raise +ve

Question 14

What is the management of Sciatica ?

Answer 14

NSAIDs (if Congress codeine)+ PPI monitoring of pain + physiotherapy with/without CBT
2nd Line: Referral to chronic pain specialist: Epidural injection
Surgery: Spinal decompression