patient presenting with back pain Flashcards
what nerves cause referred pain through the leg
femoral (front)
sciatic (back)
questions to ask about pain
SOCRATES loss of function- how much is it affecting the patient trauma previous surgery symptoms in other systems
physical examination for back pain
look - (how patient walks in and out, for pathology)
feel - spinal tenderness, paravertebral muscles, get patient to show u where
move - flexion, extension, lateral, flection, SLR, tone, power, reflexes
what investigations do you do for back pain
usually none
ESR, plasma viscosity, calcium/alkaline phosphate
rarely X-ray
MRI -best as most back pain is soft tissue
when is x-ray indicated
red flags, significant trauma or known osteoporosis
when is MRI indicated
red flags, considering surgery, sciatica >4 weeks or spinal claudication
radiological signs of osteoarthritis
Loss of joint space
Osteocyte formation
Subchondral cysts
Sclerosis
most common cause of back pain
mechanical/non specific
3 rare causes of back pain
tumour/metastasis
ankylosing spondylitis
infection
what are 8 red flags for back pain
Age <20 or >50 Thoracic pain (lumbar v common) Previous carcinoma Immunocompromised Feeling unwell (over a long time) Weight loss Wide spread neurological symptoms Structural spinal deformity
common cancers that metastasise to spine
breast
bronchus
prostate
what are 9 yellow flags for back pain
Low mood High pain levels/disability Belief that activity is harmful Low educational level Obesity Legality problems Job dissatisfaction Light duties not available at work Lot of lifting at work
how to manage back pain
explanation reassurance encourage to mobilise positive mental attitude analgesics (paracetamol, co-analgesics, opiates) NSAIDS Diazepam (v short term), muscle relaxant physiotherapy osteopathy and chiropractic referral
when does the spinal cord end
L1
