Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 @ UoN - Musculoskeletal & MDD > Neck & Back Pain > Flashcards

Neck & Back Pain Flashcards

1
Q

What is the differential diagnosis for neck pain?

A 
Trauma (inc. whiplash)
Mechanical neck pain
Cervical spondylosis
Cervical myelopathy
Ankylosing spondylitis
Fibromyalgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a whiplash injury?

A

Injury caused by acc-decc forces applied to the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes a whiplash injury?

A

Acc-decc forces

Typically RTA w/ pt wearing seatbelt, struck from behind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does a whiplash injury present?

A

Pain in neck/shoulder/arm
Headache
Dizziness
Memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is whiplash injury managed?

A

Symptomatic management
Can take months to settle
Radiology only indicated if ?bone injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes mechanical neck pain?

A

Post injury
Falling asleep in awkward positions
Prolonged keyboard working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does mechanical neck pain present?

A 
Pain
   -associated w/ palpable muscle spasm
   -can radiate up to occiput
Tension headache
Associated w/ fibromyalgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What causes Cervical Radiculopathy/Brachial Neuralgia?

A

Compression of cervical neck roots

  • typically osteophytes in older populations
  • acute cervical disc prolapse following minor trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does Cervical Radiculopathy present?

A

Aching pain in neck, going down arm
-sudden sharp pains down arm
Progression to mild loss of pinch grip strength
Dermatomal sensory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Spurling’s test?

A

Recreates sudden pain of Cervical Radiculopathy

  • turns pts head to affected side
  • extends & applies downward pressure to top of head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations are appropriate in suspected Cervical Radiculopathy?

A

XR/MRI

Refer to neurosurgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes Cervical Myelopathy?

A

Compression of cervical spinal cord

  • osteophytes
  • cervical disc degeneration
  • malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Cervical Myelopathy present?

A

Older pts
Problems w/ fine motor control in hands
Slowly developing spastic gait
Pain NOT predominant feature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the signs on examination of Cervical Myelopathy?

A

UMN signs below level of compression
LMN signs at level of compression
Hoffman’s +ve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Hoffman’s sign?

A

Sign of UMN disease

-flicking distal phalanx leads to flexion of other fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What investigations are appropraite in suspected Cervical Myelopathy?

A

XR/MRI

Ref to neurosurgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What life threatening visceral pathology should be ruled out when investigating back pain?

A

AAA
MI
Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common cause of back pain?

A

Simple mechanical back pain (90%)

-resolves spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the red flag sx present in back pain that indicate severe pathology?

A 
Age <20 or >55
Constant/progressive pain (e.g. at night)
B sx
Bladder/bowel sx
History of TB/HIV/Malignancy
Pain in thoracic spine
Hx of significant trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the red flag signs present in back pain that indicate severe pathology?

A 
Saddle anaesthesia (cauda equina)
Point midline tenderness on palpation (malignancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does simple mechanical back pain present?

A 
20-55yr old
Pain
   -came on suddenly when lifting
   -varies w/ physical activity/posture/time
   -referred to buttocks/thighs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the signs on examination of simple mechanical back pain?

A

Palpable muscular spasm

-causes local pain/tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When can a diagnosis of simple mechanical back pain be made?

A

When clinician is satisfied there is no specific cause for the pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is simple mechanical back pain be managed?

A

Simple analgesia
Advice to keep active w/ normal activities
Physiotherapy exercises

25
Q

What is the prognosis of simple mechanical back pain?

A

90% recover w/i 6wks

-re-assess if not resolved

26
Q

What causes Acute Lumbar Disc Prolapse & Nerve Entrapment?

A

Nucleus pulposus of disc herniates into spinal canal

-precipitated by lifting/sneeze

27
Q

Where does Acute Lumbar Disc Prolapse & Nerve Entrapment most commonly occur?

A

L4/L5 OR L5/S1

28
Q

How does Acute Lumbar Disc Prolapse & Nerve Entrapment present?

A 
2nd-4th decade
Triggering event known after which pt is seized up w/ pain &amp; unable to straighten up
   -worse on coughing/straining
   -move into buttock w/i hrs, into leg w/i 1/2 days
Radicular pain
Bladder/bowel sx
Cauda equina syndrome
Self-limiting lower back pain
29
Q

What is radicular pain?

A

Severe lancinating pains & paraesthesia/numbness in one leg due to compression of sciatic nerve root

  • can rarely affect both legs
  • associated clumsiness of foot
30
Q

What are the signs on examination of Acute Lumbar Disc Prolapse & Nerve Entrapment?

A 
Pt may walk w/ flexed leg/obvious scoliosis
Palpable muscle spasm
Straight leg raised to 30o causes pain
   -if +ve w/ contralateral leg suggests large lesion
Femoral stretch test +ve
Muscle weakness
Loss of sensation
Diminished reflexes
31
Q

What are the muscles most commonly affected by Acute Lumbar Disc Prolapse & Nerve Entrapment?

A

Extensor hallicus longus & tibialis ant
-L4 (extension toe, dorsiflexion foot)
Peroneus longus/brevic
-L5 (foot eversion)
Gastrocnemius/soleus
-S1/2 (plantar flexion)

32
Q

What is the femoral stretch test?

A 
Screens for nerve root impingements
   -pt lies prone
   -knee passively flexed to thigh
   -hip passively extended 
Positive if pain experienced
33
Q

What examinations must always be performed to rule out cauda equina?

A

PR (no sensation, loss of anal tone)
Bladder palpation (signs of retention)
Check sensation of saddle area

34
Q

What investigations may be appropriate in suspected Acute Lumbar Disc Prolapse & Nerve Entrapment?

A

Thorough hx to separate referred pain from true nerve root pain
-natural hx is relapsing/remitting episodes

35
Q

What is the initial management of Acute Lumbar Disc Prolapse & Nerve Entrapment?

A

Anti-inflammatories & bed rest w/ knees slightly flexed
Bed rest for 2wks
-reduces herniation in >90%

36
Q

What is the management of Acute Lumbar Disc Prolapse & Nerve Entrapment w/ sx persisting at 2wks?

A

Epidural injections (treat radicular sx)
MRI/surgical referral indicated
Microdiscectomy (single level disease)
Rehabilitation w/ physiotherapist

37
Q

What is the emergency management of Cauda Equina syndrome?

A

Emergency MRI

Urgent surgical intervention

38
Q

What causes Lumbar Canal Stenosis?

A

Degeneration of spine

  • facet joint hypertrophy
  • ligamentum flavum hypertrophy
  • disc degeneration
  • OA
39
Q

How does Lumbar Canal Stenosis present?

A

Sx of spinal claudication

  • aching pain in legs on walking
  • pain recovers slowly on sitting/bending forwards
  • numbness/stiffness/weakness
  • variable day-day
40
Q

What is the management of Lumbar Canal Stenosis?

A

Depends on stable/progressive course
Conservative - activity modification, physiotherapy
Surgical - laminectomy (OA related back pain remains)

41
Q

What are facet joints responsible for?

A

Keeping vertebrae in AP alignment

42
Q

What is Spondylolisthesis?

A

Condition where one vertebra is displaced either ant/post on vertebra below

  • anterolisthesis
  • posterolisthesis
43
Q

Where does Spondylolisthesis most commonly occur?

A

L4/L5

L5/S1

44
Q

How does Spondylolisthesis present?

A

Intermittent backache
Precipitated by exercise/strain
Step found on palpation

45
Q

What causes Spondylolisthesis?

A 
Spondylosis
   -most commonly stress fracture of lumbar pars articularis
Dysplasia of lumbosacral facet joints
OA of facet joints
Extreme athletes
46
Q

How is Spondylolisthesis managed?

A

Managed conservatively as per simple mechanical back pain
Spinal fusion if pt young/disabling sx
Cauda equina may develop

47
Q

What causes facet joint dysfunction?

A

OA/RA

Minor trauma

48
Q

How does facet joint dysfunction present?

A

Acute/chronic back pain

  • worse on extension of back/in morning/on standing
  • no hx of pain in legs
  • localised tenderness over facets o/e
49
Q

What are the four types of non-mechanical back pain?

A

Inflammatory
Infection
Metabolic
Neoplastic

50
Q

How does inflammatory back pain present?

A

Insidious onset of stiffness/pain

  • worse in morning
  • associated w/ systemic upset
51
Q

How does infective back pain present?

A

Localised pain/raised inflammatory markers

-post spinal surgery/injection

52
Q

How is infective back pain managed?

A

Admission for IV a/b

53
Q

What are the causes of metabolic back pain?

A 
Osteoporotic wedge fractures
Thoracic lyphosis
Myeloma
Paget's disease
HyperPTH
54
Q

How does metabolic back pain present?

A

Asymptomatic

Localised pain radiating around ribs

55
Q

What investigations may be appropriate in metabolic back pain?

A

XR (wedging, loss of ant vertebral body height)

56
Q

What are the causes of neoplastic back pain?

A 
1o tumours
2o mets (most common)
57
Q

What are the most common 1o sites of bony mets?

A 
Lung
Breast
Kidney
Prostate
Thyroid
58
Q

How does neoplastic back pain present?

A

Progressive pain

  • particularly at night
  • no exacerbating/relieving factors
  • pain over particular bony segment

CP3 @ UoN - Musculoskeletal & MDD (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions