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Neurology II > Pain Of The Back, Neck And Extremities > Flashcards

Pain Of The Back, Neck And Extremities Flashcards

1
Q

What are the purpose of the anterior and posterior spine?

A

Anterior spine = primarily absorbs shock
Posterior spine = anchor for attachment of muscles and ligaments

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2
Q

What are the diff types of back pain?

A

Local pain - sensory nerve endings
Pain referred to the back - abdominal or pelvic viscera
Pain of spine origin
Radicular back pain - sharp in character
Pain associated with muscle spasm - abnormal posture

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3
Q

How do you examine back pain?

A

Complete general PE
Inspection & palpation of the spine and paravertebral muscles
ROM of the spine
Straight leg-raising test
Complete neurological exam
Risk factors of acute low back pain

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4
Q

What test should be positive to indicate Pyelonephritis along with back pain?

A

Goldflam test or costovertebral angle tenderness

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5
Q

What test is done to assess a patient’s lower back pain?

A

Straight leg-raising test

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6
Q

What is the effect of a (+) SLR?

A

Reproduction of the patient’s pain (irritation of L5-S1 nerve roots + sciatic nerve)

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7
Q

What should be watched out for in neurological exam of lower back pain complaints/

A

Focal weakness
Muscle atrophy
Reflex changes (hyper/areflexia)
Diminished sensation
Signs of spinal cord injury/involvement

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8
Q

What are the risk factors of acute low back pain?

A

Acute low back pain
Headache + low back pain = redflag
Prior hx of cancer
Incontinence
>70 yrs old
IV drug use
Glucocorticoid use
Hx of rapidly progressive neurologic deficit

Patrick’s sign or heel percussion sign

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9
Q

What is the course of management for px with acute low back pain within <6 weeks with no neurologic deficit and absence of red flags?

A

Local spine problem/disk problem with no herniation
May respond to conservative treatment

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10
Q

What are the diff causes of back or neck pain?

A

Degenerative spine disease
Spine infection
Neoplasms
Trauma
Metabolic spine disease
Congenital/developmental
Autoimmune inflammatory arthritis

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11
Q

What are the congenital anomalies of the lumbar spine?

A

Spondylosis
Spondylolisthesis
Spina bifida occulta
Tethered cord syndrome

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12
Q

What congenital anomaly of the lumbar spine presents with failure of closure of vertebral artches posteriorly?

A

Spina bifida occulta

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13
Q

What congenital anomaly of the lumbar spine is caused by anterior slippage of certain structures such as vertebral body, pedicles, and facets?

A

Spondylolisthesis

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14
Q

What is a congenital anomaly of the lumbar spine caused by bony defect in vertebral parts interarticularis?

A

Sponylolysis

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15
Q

Where is the common site of lumbar disk disease?

A

L4-L5, L5-S1 levels
Overweight persons are more prone

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16
Q

What is a possible sequelae of ruptured disk where there is an underlying cause of injury to the multiple lumbosacral nerve roots?

A

Cauda equina syndrome

17
Q

What are the tell signs of Cauda Equina syndrome?

A

Low back pain + leg weakness + leg areflexia + saddle anesthesia + loss of bladder function

KEY points: fever, constant pain, sphincter abnormalities, signs of spinal cord disease

18
Q

What is a cause of degenerative lower back pain?

A

Lumbar spinal stenosis

19
Q

What are the S/Sx of Lumbar spinal stenosis and its treatment?

A

Signs: walking and standing induces pain, sitting relieves the pain

Treatment: conservative before surgical

20
Q

What are the different arthritic conditions that can induce lower back pain?

A

Spondylosis
Disk-osteophyte complex
Ankylosing spondylitis

21
Q

What are tells of Ankylosing spondylitis?

A

Relieved by exercise
Young males <40 yrs
Elevated ESR

Image findings: bamboo spine

22
Q

What are tells of Spondylosis?

A

More common in the elderly
Back pain aggravated by movement

23
Q

What is a red flag in lower back pain caused by neoplasms?

A

Back pain unrelieves by rest and worse at night

24
Q

What are diff infections/inflammatory condition that can occur with low back pain?

A

Vertebral osteomyelitis - TB (local setting) or bacterial
Spinal epidural abscess - back pain, fever, radiculopathy, signs of spinal cord compressions

25
Q

How do you classify back pain as acute or chronic?

A

Acute = <12 weeks duration
Chronic >12 weeks duration

26
Q

Can acute low backpain without radiculopathy spontaneously improve?

A

Yes, but it will take time so u need to address signs and symptoms

27
Q

What are the different conservative tx of back pain?

A

1st line : OTW pain-relievers

Opioids & Tramadol - refractory severe pain

Early resumption of ambulation/physical activity

28
Q

What are non-pharmacologic treatment of acute lower back pain without radiculopathy (ALBP)?

A

Spinal manipulation
PT
Massage
Acupuncture
Transcutaneous electrical nerve stimulation

29
Q

What are the conservative treatments of chronic lower back pain without radiculopathy?

A

NSAIDs, acetaminophen, TCA -> epidural glucocorticoids lack evidence

30
Q

What are non-pharmacological tx of CLBP?

A

Exercise therapy
Spinal manipulation
Acupuncture
massage
Yoga
Cognitive-behavioral therapy

31
Q

What is the most common cause of low back pain with radiculopathy?

A

Favorable prognosis

Early resumption of activity

Epidural glucocorticoids - temporary symptom relief

Surgery= cauda equina syndrome, disabiling pain not responsive to medical management

32
Q

What are the presentation of Thoracic outlet syndrome?

A

Subclavian vein = discoloration/edema of arm

Subclavian artery = limb ischemia, unilateral Raynaud phenomenon, brittle nails, ulceration of fingertips

Nerve = arm pain, forearm numbness, weakness/wasting of hypothenar, interosseous, adductor policis, deep flexor muscles of the 4th/5th digit

33
Q

What are the causes of Thoracic outlet syndrome?

A

Incomplete cervical rib, fibrous band, anomalous insertion of scalene muscles

34
Q

What is the most commonly affected nerve root in Cervical disc herniation?

A

C7 root

35
Q

What are the sequelae of cervical disc herniation?

A

Root compression = result of compressive syndromes: pain + weakness + reflex change

Spinal cord compression (myelopathy_

36
Q

What is the clin presentation of Cervical spondylosis?

A

Neck/arm pain, spinal cord compression (main effect)

37
Q

What is the appearance of Cervical Spondylosis in radio imaging?

A

Bony ridges (“spurs”) in the spinal canal -> comression of spinal cord and roots

Central disc protrusion + calcification

Neurology II (7 decks)

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