OME - Back Pain Flashcards
Alarm symptoms for back pain?
- Incontinence
- Saddle anesthesia
- New neuro deficit
- Rapidly progressing deficit
Rx cord compression?
- Steroids IV
Work up for cord compression?
- Xray
2. MRI
Rx Cord compression?
- Hematoma - drainage
- Abscess - Abx + ID
- Cancer - Radiation
- Fracture - Surgery
Rx msk back pain?
- NSAIDs
- Exercise
- Reassess after four weeks
* **Never say bedrest
What type of back pain is bed rest good for?
This is never the answer
What to do if pain doesn’t improve after 4 weeks exercise and NSAIDs?
- Xray
2. MRI if Xray negative
Presentation MSK back pain??
- Young male
- Pain on lifting something heavy
- “Belt like pain”
Presentation disk herniation?
- Heavy lifting
- Sciatica
- Positive straight leg raise test
Pathophys herniated disk?
Nucleus pulposus pinching nerve after heavy lifting
What is sciatica?
Lighting shot pain down leg
What does positive straight leg raise test diagnose?
- Herniated disk
2. Osteophyte
Diagnosis herniated disk?
- Xray - Usually negative
2. Follow up MRI
Rx herniated disk?
- Surg better than conserve mgmt at 6 mo
2. Both equal at 1 year
How to treat back pain from osteophyte?
Surgery - does not get better with conservative management like herniation will
RF compression fracture?
Osteoporosis - usually in older women
Presentation compression factor?
- Older women falling on but
- vertebral step offs on exam
- Pinpoint tenderness
Presentation spinal stenosis
- Older patient
- Pseudoclaudication in but and thighs
- Pain butter going uphill or hunching over
- Worse when upright or walking around
Cause spinal stenosis?
Narrowing spinal canal pinching the nerve
Rx spinal stenosis?
Lamenectomy
