Non-Neuromusculoskletal Sources of Neck and back pain Flashcards
1
Q
What are some common serious spinal pathologies and their incidence
A
- 4% compression fractures that typically occur in >50 years old
- 3% spondylolysis <20
- malignant neoplasm is most common systemic disease effecting the spine (1% of patients with LBP)
2
Q
What cancers typically cause spinal metastases
A
- breast
- lung
- prostate
3
Q
Cancer and LBP red flags
A
- unexplained weight loss
- pain >1 month (doesn’t go along with phases of healing)
- failure to improve with conservative therapy
- pain that is not relieved with recumbency
4
Q
How can cancer cause pain
A
- tumor creates pressure on pain sensitive structures
- tumor causes obstruction of host tissue’s blood supply
- tumor causes obstruction of host organ function
- tumor causes tissue destruction due to pressure necrosis/ulceration
5
Q
How do visceral structures refer symptoms
A
- embryologic development
- multisegmental innervation
- direct pressure/shared pathways
6
Q
Embryologic development as a referred symptoms theory
A
- pain is referred to site where organ was located in fetal development
- where the tissue developed
7
Q
Multisegmental innervation
A
- major visceral organs are innervated by afferent fibers from multiple spinal levels
- shared innervation
8
Q
Direct pressure and shared pathways as a symptom referral
A
- organs impinging the respiratory diaphragm can refer pain
- C3-C5 is diaphragm innervation and can cause symptoms elsewhere
9
Q
Potential sources of neck and back symptoms
A
- lung
- liver
- heart
- esophagus
- stomach
- kidney
- gall bladder
- pancreas
- GI tract
- uterus
- spleen
- aorta
- diaphragm
- bladder
- ureter
- prostate
10
Q
Neck symptoms can refer from
A
- lung
- liver
- heart (usually left side)
- esophagus
11
Q
Thoracic and rib pain can refer from what structures
A
- heart
- lung
- stomach
- kidney
- gall bladder
- pancreas
- esophagus
12
Q
lumbar pain can refer from
A
- GI
- bladder
- ureter
- uterus
- kidney
- aortic aneurysm
13
Q
Shoulder pain can refer from
A
- heart
- lung
- gall bladder
- spleen
- pancreas
- diaphragm
- esophagus
- liver
- kidney
- aortic aneurysm
14
Q
Buttock, hip and thigh pain can refer from
A
- GI
- uterus
- prostate
- kidney
15
Q
History of symptoms to figure out if is mechanical or medical
A
- is there a hx of mechanical injury
- is the cause unknown
- can occupation, recreational interest or hobbies explain symptoms
- do past illnesses, injuries, and or surgeries provide insight
- looking for mechanical causes, if not found need to consider other potential sources
16
Q
mechanical onset of symptoms
A
- sudden with mechanical event
- gradual from cumulative trauma
17
Q
Systemic onset of symptoms
A
- slowly without mechanical event
- could be cancer growing
18
Q
Vascular onset of symptoms
A
- sudden and sharp without mechanical event
19
Q
Frequency of mechanical symptoms
A
- intermittent
- most MSK pain relieved or diminished with certain positions that will remove stress
- constant pain = systemic as often no influence with positional changes
20
Q
Red flags for back pain
A
- age less than 20 or > 50
- previous history of cancer
- consitutional symptoms
- recent urinary tract infection
- history of injection drug use
- immunocompromised condition
- failure to improve with conservative care
- pain not relieved by recumbency
- severe constant night pain
- progressive neurological deficit
- saddle anesthesia
- back pain with abdominal, pelvic or hip pain
- Hx of falls or trauma
- significant morning stiffness in all spinal motions
- skin rash
not to memorize but look over
21
Q
Viscerogenic causes of neck and back pain?
A
- cancer
- cardiovascular
- pulmonary
- Renal/urologic
- Gastrointestinal
- gynecologic
22
Q
Cervical Cancer
What types of cancer
A
- Metastatic Lesion
- Cervical Bone tumors
- cervical cord tumors
- lung cancer; pancoast tumor
- esophageal cancer
- thyroid cancer
23
Q
Cancer: Thoracic
A
- mediastinal tumors
- metastatic extension
- pancreatic cancer
- breast cancer
24
Q
Lumbar Cancer
A
- metastatic lesion
- prostate cancer
- testitular cancer
- pancreatic cancer
- colorectal cancer
- multiple myeloma
- lymphoma
25
Cardiopulmonary: symptoms in the cervical/thoracic
- angina
- myocardial infarction
- aortic aneurysm
26
Cardiopulmonary: lumbar symptoms
- abdominal aortic aneurysm
- endocarditis
- myocarditis
- peripheral vascular: post-op bleeding from anterior spine surgery
27
Pulmonary: cervical symptoms
| can be caused by
- lung cancer; pancoast tumor
- tracheobronchial irritation
- chronic bronchitis
- pneumothorax
28
Pulmonary conditions that can refer to thoracic symptoms
- respiratory or lung infection
- emphysema
- chronic bronchitis
- pleurisy
- pneumothorax
- pneumonia
29
Renal/urologic: thoracic
- acute pyelonephritis
- kidney disease
30
Renal/urologic: lumbar
- kidney disorders:
- acute pyelonephritis
- perinephritic abcess
- nephrolithiasis
- ureteral colic
- UTI
- dialysis
- renal tumors
31
Gastrointestinal in cervical region
- esophagitis
- esophageal cancer
32
GI: thoracic region
| conditions
- esophagitis
- esophageal spasm
- peptic ulcer
- acute cholescystitis
- biliary colic
- pancreatic disease
33
GI: lumbar
| conditions that could refer to this area
- small intestin: obstruction, irritable bowel syndrome, crohn's disease
- colon: diverticular disease
- pancreatic disease
- appendicitis
34
Gynecologic: lumbar
- cancer
- retroversion of uterus
- uterine fibroids
- ovarian cysts
- endometriosis
- pelvic inflammatory disease
35
Gynecologic lumbar
- incest/sexual assult
- rectocele, cystocele
- uterine prolaspe
- normal pregnancy
- multiparity
36
Other things that can refer to the spine
- infection: vertebral osteomyelitis, meningitis, herpes zoster, HIV, lyme disease
- osteoporosis
- fibromyalgia
- psychogenic
- fracture
