PIVD and mechanical backache Flashcards
In back pain what symptoms is it especially important to ask about?
Neurological symptoms such as :
numbness
paraesthesia or weakness
temperature disturbance
less than 18cm on Scohber’s
pathological stiffness
more than 24cm on Scohber’s
hyper mobility
L1/2 innervated the muscles involved in …… How is this tested?
hip flexion
ask the patient to push up against your hand
What is a myotome
The group of muscles that a single spinal nerve innervates.
L3/4 innervates the muscles involved in….. How is this tested?
knee extension
Ask the patient to straighten their knee against your hand
L5 innervates the muscles involved in….
foot dorsiflexion and EHL
S1/2 innervates the muscles involved in… Name a way that the deficit may be made more obvious for examination purposes
ankle plantarflexion
Asking the patient to stand on tiptoe
What does straight leg raise look for?
Reproduction of neurological pain
You can add in further extension of the foot (sciatic stretch test) or pressure behind the knee (bowstring test)
What is the femoral stretch test?
Best done on the side. Most patients uncomfortable with lying prone so don’t get a good test
Looking for reproduction of leg pain (if back then not really showing anything)
Examples of overt pain behaviour?
guarding bracing rubbing grimacing sighing
What scans are used in back pain?
X-rays useless as almost inevitably they will show something
MRI is GOLD STANDARD
What is a little white triangle on an MRI?
Annular tear
What is sciatica?
Buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance
What is disc prolapse?
variety of syndromes and presentations episodic back pain onset of leg pain +- neurology leg pain becomes dominant( back pain may disappear entirely) myotomes and dermatomes
Is disc prolapse an emergency and why?
NOT an emergency unless caudal equina
70% settle in 3 months
90% settle in 18-24 months
When is surgery performed with disc prolapse?
if not resolving after 3 months
long term results the same whether operated or not- surgery just speeds up the natural process
Management of backache through conservative treatment
short bed rest only if necessary
anti-inflammatory +- muscle relaxant
mobilise thereafter and return to normal activities
What is the initial management of backache in secondary care?
physiotherapy, with an educational and reassurance role
One of the problems that can result from back surgery is ASD- what is this?
Adjacent Segment Disease
-Increasing problem
What are adverse factors in spinal surgery?
Litigation
Dispute with DSS
Chronic pain syndrome/behaviour
Examples of dysfunctional syndromes
Back pain chronic fatigue syndorme fibromyalgia irritable bowel syndrome migraine/chronic headache chronic pelvic pain
What is the third most common symptom after headache and tiredness in back pain?
co-morbidity
define stress
normal emotion in response to life
define distress
excess of abnormal stress response
