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Q2 Clin Med Test 3 (musculoskel) > Neck, Low Back Pain > Flashcards

Neck, Low Back Pain Flashcards

1
Q

Strain

A

muscle-tendon injury

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2
Q

Sprain

A

ligament injury

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3
Q

Compression pain from?

A

nerve root leaving spine pinched or irritated

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4
Q

Radiculopathy is?

A

nerve root dysfxn

signs/sxs in dermatomal distribution

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5
Q

Sciatica is?

A

Radiculopathy in root (L4, L5, S1)

sxs along post or lateral lower leg
(U) to ankle/foot

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6
Q

Myelopathy presentation

A 
(Upper motor neuron)
Hyperactive reflexes
Spasticity
Weakness
Atrophy
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7
Q

Radiculopathy presentation

A 
(Lower motor neuron)
Hypoactive reflexes
Flaccidity
Weakness
Atrophy
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8
Q

What two systems should you always check together?

A

musculoskeletal and neurological

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9
Q

Secondary Gain is?

A

Pt looking for a benefit from their pain:

  • drug seeking
  • disability (work comp, etc)
  • lawsuit
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10
Q

Diagnostic studies

A

CT: best for bony detail
MRI: best for soft tissue, neural
Bone Scan: best for infection, metabolic disease

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11
Q

Neurophys studies

A

EMG: for root vs peripheral vs plexus nerves

Nerve Conduction: for axon vs myelin

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12
Q

Findings on spine films

A
  • misalignment
  • narrow disk space
  • osteophytes (esp on intervert foramina)
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13
Q

Cervical Strain/Sprain etiology

A

rapid deceleration w/ hyperextension then flexion of neck

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14
Q

Cervical Strain/Sprain presentation

A

(U) presents 2-24 hrs post trauma

  • gradual onset stiff/sore
  • (P) tension-type HA
  • (P) shoulder pain
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15
Q

Lumbar Strain/Sprain etiology

A

secondary to event (e.g. twist, lift)

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16
Q

Lumbar Strain/Sprain presentation

A
  • acute onset post event
  • (U) worse w/ activity
  • (U) radiates to butt
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17
Q

Physical Exam for Strain

A
  • may be normal initially
  • (P) ↓ ROM 2° to pain
  • (P) tender to palpation
  • normal neuro exam
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18
Q

Diagnostics for Strain

A

X-ray:

Cervical

  • AP/Lat/Odontoid
  • must see C7
  • flex/ext if c-spine cleared

Lumbar
-AP/Lat

CT/MRI: rarely helpful

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19
Q

Strain tx

A

48 hr Theraputic Trial (conservative):
limited activiy
ice/heat
NSAIDS round the clock

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20
Q

Clinic Course for Strain

A

1/2 resoluve <4wks

5-10% become chronic

21
Q

Cervical Spondylosis etiology

A

combo of disk degener/hypertrophy of lig flavum and facets

2nd most common cause neck pain

22
Q

Cervical Spondylosis presentation

A
  • (P) single level involvement w/ unilat radicular sxs
  • (P) multi-level w/ bilat sxs
  • (P) nyelopathy if disk herniation compresses cord
23
Q

Cervical Spondylosis physical exam (check for)

A
  • tenderness, spasm
  • radicular sxs (low motor neuro findings)
  • cord comress (up motor)
  • uni or bilateral
  • levels affects (U) C4-7
24
Q

Cervical Spondylosis tests

A

MRI = extensive disease, bulging disks, lig hypertrophy

25
Q

Herniated Lumbar Disk Disease findings

A
  • disks proturde, extrude or free fragments
  • herniation (U) L4-5 or L5-S1
  • herniation (U) posterolateral (longitudinal lig is weakest)
26
Q

Herniated Lumbar Disk Disease presentation

A

(from repetitive movements)

  • SCIATICA sxs
  • (P) trunk shift
  • (P) neuro defects following dermatome
27
Q

Herniated Lumbar Disk Disease tests

A 
x-ray = (P) ↓ disk space, osteophytes
MRI = will be diagnostic
28
Q

Cervical/Lumbar Spondylosis tx

A

Theraputic Trial (conservative):

  • Short rest
  • NSAIDS
  • cyclobenzaprine (m relax)
  • heat/cold

Urgent referral for neuro defects

29
Q

Cauda Equina Synd etiology

A

NEURO EMERGENCY
massive midline herniation
(P) also from trauma or metastatic dx

30
Q

Cauda Equina Synd presentation

A
  • acute LBP w/ sciatica
  • ANY ∆ in bowel/bladder
  • “saddle” anesthesia: butt, post/sup thighs, perinea
  • global or progressive bilat LE mm weakness
31
Q

Cauda Equina Synd tests

A

MRI

32
Q

Cauda Equina Synd tx

A

herniation or trauma = urgent surgical decompression

metastatic dx = urgent oncology for radiation

33
Q

Spondylolysis etiology/tx

A

defect in pars interarticularis from repeat hyperextension (e.g. athletes)

(U) kids/adoles

tx w/ NSAIDS and rest if LBP

34
Q

Spondylolisthesis etiology

A

ant displacement of one vertebra onto another
(U) w/ degen disk dxs
(U) L4-5, L5-S1

35
Q

Spondylolisthesis presentation

A

LBP ↑ w/ movement, 2º to instability

If root compression, herniated disk sxs

36
Q

Spondylolisthesis tests

A

X-ray including ext/flexion

37
Q

Spondylolisthesis tx

A

Depends on grade of displacement:

50% displ: spinal fusion

Neuro impairment = refer ortho/neuro

38
Q

Lumbar Spinal Stenosis etiology

A
  • Acquired or congenital
  • Degenerative disk dx w/ hypertrophy of ligamentum flavum
  • Narrows neural foramen -> compresses nerve or cord
  • MOST COMMON cause of neuro leg pain in old people
39
Q

Lumbar Spinal Stenosis presentation

A

Neurogenic claudication:
progressive LBP w/ bilat leg pain

  • pain ↑ w/ stand, walk
  • RELIEF by LEANING FORWARD
40
Q

Lumbar Spinal Stenosis imaging findings

A
  • ↓ height of intervert discs
  • facet hypertrophy
  • lig flavum hypertrophy
  • narrow intervert foramina
41
Q

Lumbar Spinal Stenosis tx

A

Conservative:
NSAIDS, PT

(P) steroid inject or surgery

42
Q

Spinal Tumors etiology

A

Primary tumors rare: multiple myeloma

Metastatic common: most terminal CA include spine tumors

43
Q

Spinal Tumors presentation

A

NIGHT PAIN, dull, progressive

44
Q

Osteomyelitis etiology

A

infection assoc w/

invasive procedures, DM, ↓ immun

45
Q

Osteomyelitis presentation

A

back pain, malaise, fever
sepsis, wound drainage

↑ ESR

46
Q

Osteomyelitis tx

A

abx

surg drainage

47
Q

Red Flag/Alarm sxs with neck/back pain

A
  • old, immun suppressed, IV drug user
  • hx of CA
  • pain > 1 mo
  • fever
  • UTI
  • worse when supine
  • unexplained weight loss
48
Q

Red Flag for Spinal Frx

A
  • hx significant trauma
  • long use of corticosteroids
  • Age >70

Q2 Clin Med Test 3 (musculoskel) (5 decks)

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