Non-specific low back pain Flashcards
hx
24 yr old accountant 6 month hx of pain in lumbar spine, worse over past few wks, can’t play rugby, v stiff back in morning, took 1 diazepam gave great relief, no hx of trauma other than playing rugby, otherwise well
look
loss of lumbar lordosis
assess for scoliosis, spinal scars
feel
tenderness over lumbar area
feel along spinous processes and paraspinal muscles
active movement
pain limited active ROM of lumbar spine movements
Schober test to establish loss of flexion of lumbar spine
FABER test to check SI joint
passive and resisted movements
not expected
special tests
SLR
wall test
other
full lower limb near exam
DDx
non-specific low back pain
herniated nucleus pulposus/ disc prolapse
spondylolithesis
spondyloarthropathy
why is mechanical lumboscrmal pain likely?
young age of pt
plays sports
relieved by muscle relaxant
why is disc prolapse unlikely?
no radicular pain, no neurological signs
why is spondylolithesis unlikely?
no bilateral radicular pain
why is spondyloarthropathy unlikely?
ankylosing spondylitis and Reiters syndrome
low back or buttock pain, morning stiffness, generalised fatigue
investigations if mechanical low back pain suspected
none
investigations if ankylosing spondylitis and Reiters syndrome
plain film of spine and SI joints
why not MRI
high rate of incidental findings
unnecessary worry and further investigations
