Ortho week 2 - back pain

Question 1

What are the red flags associated with spinal/back pain ?

Answer 1

• aged <20 or >50
• fever
• weight loss
• progressive or constant pain at night or when lying flat
• alcohol or drug use
• reduced appetite
• history or cancer
• bowel/bladder symptoms
• weakness/numbness
• significant trauma

Question 2

What are the main symptoms of cauda equina syndrome, other than back pain ?

Answer 2

• weakness of both legs
• ‘saddle anaesthesia’ (numbness of bum/both legs)
• incontinence or retention (bladder or bowel)

Question 3

which vertebrae is the first palpable one in most patients ?

Answer 3

C7 at base of neck

Question 4

List the body landmarks that can be used to guesstimate which vertebrae you are looking at/feeling …

Answer 4

• C7 - base of neck
• T4 - spine of scapula
• T7 - inferior angle of scapula
• L3/4 - umbilicus

Question 5

What special test can be used to assess/quantify forward flexion of the spine ?

Answer 5

modified Schobers test

Question 6

How do you do the modified Schobers test?

Answer 6

• patient stood straight, feet hip width apart
• find posterior iliac spine
• place a mark 5cm below and 10cm above this point
• ask Pt to bend over “touch toes with straight knees”
• measure new distance between the 2 marks
• find difference between the 15cm and new measurement, that is the ‘score’

‘score’ should be 5 or more
<5 is indicative of ankylosis spondylitis

Question 7

What is one condition you could use the modified schobers test to check for?

Answer 7

ankylosis spondylitis
would see reduced lumbar flexion <5cm

Question 8

In the case of MSK or mechanical back pain with no red flags, what would be the management ?

Answer 8

• patient education of red flags
• analgesia
• return to normal activities
• avoid bed rest
• avoid precipitants
• physiotherapy and advice to mobilise

Question 9

How quick is the natural recovery of most patients with MSK/mechanical lower back pain ?

Answer 9

6-12 weeks in most patients

however 50% experience another episode within a year

Question 10

What is the Laseague’s test ?

Answer 10

it is a straight leg raise test

if the angle at which a striagh leg can be raised is <45° this is considered positive for compression or irritation of the sciatic nerve

Question 11

What does the Laseagues test look for ?

Answer 11

compression or irritation of the sciatic nerve

Question 12

In which age range are disc herniations most common ?

Answer 12

<50

Question 13

What are the predominant symptoms of sciatica ?

Answer 13

• lower back pain
• unresponsive to analgesia
• shooting pain down back of leg(s)
• weakness in legs
• tingling in bum, legs, feet

Question 14

What is the preferred imaging technique used to confirm a diagnosis of sciatica due to prolapsed disc ?

Answer 14

MRI

Question 15

What is a common method for treating resistant lower back pain ?

Answer 15

TENS - uses gate theory of pain

transcutaneous electrical nerve stimulation

Question 16

What vertebral level are disc herniations most common in cauda equina ?

Answer 16

L 3/4/5

Question 17

How many vertebrae are there of each type ?

Answer 17

7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal

Question 18

If you are in a non-hospital setting and you come across someone who you think has cauda equina, what should you do ?

Answer 18

send them to A&E for assessment and MRI

cauda equina is a medical emergency

Question 19

What is the HLA-B27 test used in diagnosis of?

Answer 19

• ankylosis spondylitis
• reactive arthritis
• juvenile RA
• anterior uveitis