Ortho: Back Pain

Question 1

Back pain less than 4 weeks

Answer 1

does not need imaging

Question 2

Spinal cord or cauda equina compression

Answer 2

Signs include new bowel or bladder incontinence, saddle anesthesia, and significant motor deficits that are either progressive or not localized to a single unilateral nerve root. need immediate MRI

Question 3

Conservative treatment for 3 months and no improvement

Answer 3

Image with a plain film and consider referrals for further evaluation and treatment

Question 4

Straight leg test

Answer 4

Radicular nature of pain

Question 5

Palpation of spine

Answer 5

Palpation and/or percussion of the back is usually performed to assess vertebral or soft tissue tenderness. Vertebral tenderness is a sensitive, but not specific, finding for spinal infection, and may also be seen in patients with vertebral metastases and osteoporotic compression fracture

Question 6

Inspection of back and posture

Answer 6

Inspection of the patient on physical examination can reveal anatomic abnormalities such as scoliosis or hyperkyphosis

Question 7

Nonorganic signs (Waddell’s signs)

Answer 7

Patients with psychologic distress that is contributing to back pain symptoms may have associated inappropriate physical signs, also known as “Waddell’s signs” superficial tenderness, straight leg raise that improves when the patient is distracted, patient overreaction during the physical examination, nondermatomal distribution of sensory loss, sudden giving way or jerky movements with motor examination, inconsistency in observed spontaneous activity