Pain Of The Back, Neck And Extremities Flashcards
What are the purpose of the anterior and posterior spine?
Anterior spine = primarily absorbs shock
Posterior spine = anchor for attachment of muscles and ligaments
What are the diff types of back pain?
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
How do you examine back pain?
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
What test should be positive to indicate Pyelonephritis along with back pain?
Goldflam test or costovertebral angle tenderness
What test is done to assess a patient’s lower back pain?
Straight leg-raising test
What is the effect of a (+) SLR?
Reproduction of the patient’s pain (irritation of L5-S1 nerve roots + sciatic nerve)
What should be watched out for in neurological exam of lower back pain complaints/
Focal weakness
Muscle atrophy
Reflex changes (hyper/areflexia)
Diminished sensation
Signs of spinal cord injury/involvement
What are the risk factors of acute low back pain?
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
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?
Local spine problem/disk problem with no herniation
May respond to conservative treatment
What are the diff causes of back or neck pain?
Degenerative spine disease
Spine infection
Neoplasms
Trauma
Metabolic spine disease
Congenital/developmental
Autoimmune inflammatory arthritis
What are the congenital anomalies of the lumbar spine?
Spondylosis
Spondylolisthesis
Spina bifida occulta
Tethered cord syndrome
What congenital anomaly of the lumbar spine presents with failure of closure of vertebral artches posteriorly?
Spina bifida occulta
What congenital anomaly of the lumbar spine is caused by anterior slippage of certain structures such as vertebral body, pedicles, and facets?
Spondylolisthesis
What is a congenital anomaly of the lumbar spine caused by bony defect in vertebral parts interarticularis?
Sponylolysis
Where is the common site of lumbar disk disease?
L4-L5, L5-S1 levels
Overweight persons are more prone
What is a possible sequelae of ruptured disk where there is an underlying cause of injury to the multiple lumbosacral nerve roots?
Cauda equina syndrome
What are the tell signs of Cauda Equina syndrome?
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
What is a cause of degenerative lower back pain?
Lumbar spinal stenosis
What are the S/Sx of Lumbar spinal stenosis and its treatment?
Signs: walking and standing induces pain, sitting relieves the pain
Treatment: conservative before surgical
What are the different arthritic conditions that can induce lower back pain?
Spondylosis
Disk-osteophyte complex
Ankylosing spondylitis
What are tells of Ankylosing spondylitis?
Relieved by exercise
Young males <40 yrs
Elevated ESR
Image findings: bamboo spine
What are tells of Spondylosis?
More common in the elderly
Back pain aggravated by movement
What is a red flag in lower back pain caused by neoplasms?
Back pain unrelieves by rest and worse at night
What are diff infections/inflammatory condition that can occur with low back pain?
Vertebral osteomyelitis - TB (local setting) or bacterial
Spinal epidural abscess - back pain, fever, radiculopathy, signs of spinal cord compressions
How do you classify back pain as acute or chronic?
Acute = <12 weeks duration
Chronic >12 weeks duration
Can acute low backpain without radiculopathy spontaneously improve?
Yes, but it will take time so u need to address signs and symptoms
What are the different conservative tx of back pain?
1st line : OTW pain-relievers
Opioids & Tramadol - refractory severe pain
Early resumption of ambulation/physical activity
What are non-pharmacologic treatment of acute lower back pain without radiculopathy (ALBP)?
Spinal manipulation
PT
Massage
Acupuncture
Transcutaneous electrical nerve stimulation
What are the conservative treatments of chronic lower back pain without radiculopathy?
NSAIDs, acetaminophen, TCA -> epidural glucocorticoids lack evidence
What are non-pharmacological tx of CLBP?
Exercise therapy
Spinal manipulation
Acupuncture
massage
Yoga
Cognitive-behavioral therapy
What is the most common cause of low back pain with radiculopathy?
Favorable prognosis
Early resumption of activity
Epidural glucocorticoids - temporary symptom relief
Surgery= cauda equina syndrome, disabiling pain not responsive to medical management
What are the presentation of Thoracic outlet syndrome?
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
What are the causes of Thoracic outlet syndrome?
Incomplete cervical rib, fibrous band, anomalous insertion of scalene muscles
What is the most commonly affected nerve root in Cervical disc herniation?
C7 root
What are the sequelae of cervical disc herniation?
Root compression = result of compressive syndromes: pain + weakness + reflex change
Spinal cord compression (myelopathy_
What is the clin presentation of Cervical spondylosis?
Neck/arm pain, spinal cord compression (main effect)
What is the appearance of Cervical Spondylosis in radio imaging?
Bony ridges (“spurs”) in the spinal canal -> comression of spinal cord and roots
Central disc protrusion + calcification
