Pt looking for a benefit from their pain: - drug seeking - disability (work comp, etc) - lawsuit

Neck, Low Back Pain Flashcards by Wendy Pitts

Strain

muscle-tendon injury

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Sprain

ligament injury

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Compression pain from?

nerve root leaving spine pinched or irritated

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Radiculopathy is?

nerve root dysfxn

signs/sxs in dermatomal distribution

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Sciatica is?

Radiculopathy in root (L4, L5, S1)

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

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Myelopathy presentation

(Upper motor neuron)
Hyperactive reflexes
Spasticity
Weakness
Atrophy

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Radiculopathy presentation

(Lower motor neuron)
Hypoactive reflexes
Flaccidity
Weakness
Atrophy

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What two systems should you always check together?

musculoskeletal and neurological

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Secondary Gain is?

Pt looking for a benefit from their pain:

drug seeking
disability (work comp, etc)
lawsuit

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Diagnostic studies

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

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Neurophys studies

EMG: for root vs peripheral vs plexus nerves

Nerve Conduction: for axon vs myelin

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Findings on spine films

misalignment
narrow disk space
osteophytes (esp on intervert foramina)

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Cervical Strain/Sprain etiology

rapid deceleration w/ hyperextension then flexion of neck

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Cervical Strain/Sprain presentation

(U) presents 2-24 hrs post trauma

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

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Lumbar Strain/Sprain etiology

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

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Lumbar Strain/Sprain presentation

acute onset post event
(U) worse w/ activity
(U) radiates to butt

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Physical Exam for Strain

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

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Diagnostics for Strain

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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Strain tx

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

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Clinic Course for Strain

1/2 resoluve <4wks

5-10% become chronic

Cervical Spondylosis etiology

combo of disk degener/hypertrophy of lig flavum and facets

2nd most common cause neck pain

Cervical Spondylosis presentation

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

Cervical Spondylosis physical exam (check for)

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

Cervical Spondylosis tests

MRI = extensive disease, bulging disks, lig hypertrophy

Herniated Lumbar Disk Disease findings

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

Herniated Lumbar Disk Disease presentation

(from repetitive movements) - SCIATICA sxs - (P) trunk shift - (P) neuro defects following dermatome

Herniated Lumbar Disk Disease tests

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

Cervical/Lumbar Spondylosis tx

Theraputic Trial (conservative): - Short rest - NSAIDS - cyclobenzaprine (m relax) - heat/cold Urgent referral for neuro defects

Cauda Equina Synd etiology

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

Cauda Equina Synd presentation

- acute LBP w/ sciatica - ANY ∆ in bowel/bladder - "saddle" anesthesia: butt, post/sup thighs, perinea - global or progressive bilat LE mm weakness

Cauda Equina Synd tests

MRI

Cauda Equina Synd tx

herniation or trauma = urgent surgical decompression metastatic dx = urgent oncology for radiation

Spondylolysis etiology/tx

defect in pars interarticularis from repeat hyperextension (e.g. athletes) (U) kids/adoles tx w/ NSAIDS and rest if LBP

Spondylolisthesis etiology

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

Spondylolisthesis presentation

LBP ↑ w/ movement, 2º to instability If root compression, herniated disk sxs

Spondylolisthesis tests

X-ray including ext/flexion

Spondylolisthesis tx

Depends on grade of displacement: 50% displ: spinal fusion Neuro impairment = refer ortho/neuro

Lumbar Spinal Stenosis etiology

- 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

Lumbar Spinal Stenosis presentation

Neurogenic claudication: progressive LBP w/ bilat leg pain - pain ↑ w/ stand, walk - RELIEF by LEANING FORWARD

Lumbar Spinal Stenosis imaging findings

- ↓ height of intervert discs - facet hypertrophy - lig flavum hypertrophy - narrow intervert foramina

Lumbar Spinal Stenosis tx

Conservative: NSAIDS, PT (P) steroid inject or surgery

Spinal Tumors etiology

Primary tumors rare: multiple myeloma Metastatic common: most terminal CA include spine tumors

Spinal Tumors presentation

NIGHT PAIN, dull, progressive

Osteomyelitis etiology

infection assoc w/ | invasive procedures, DM, ↓ immun

Osteomyelitis presentation

back pain, malaise, fever sepsis, wound drainage ↑ ESR

Osteomyelitis tx

abx | surg drainage

Red Flag/Alarm sxs with neck/back pain

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

Red Flag for Spinal Frx

- hx significant trauma - long use of corticosteroids - Age >70