PIVD and mechanical backache

Question 1

In back pain what symptoms is it especially important to ask about?

Answer 1

Neurological symptoms such as :

numbness
paraesthesia or weakness
temperature disturbance

Question 2

less than 18cm on Scohber’s

Answer 2

pathological stiffness

Question 3

more than 24cm on Scohber’s

Answer 3

hyper mobility

Question 4

L1/2 innervated the muscles involved in …… How is this tested?

Answer 4

hip flexion

ask the patient to push up against your hand

Question 5

What is a myotome

Answer 5

The group of muscles that a single spinal nerve innervates.

Question 6

L3/4 innervates the muscles involved in….. How is this tested?

Answer 6

knee extension

Ask the patient to straighten their knee against your hand

Question 7

L5 innervates the muscles involved in….

Answer 7

foot dorsiflexion and EHL

Question 8

S1/2 innervates the muscles involved in… Name a way that the deficit may be made more obvious for examination purposes

Answer 8

ankle plantarflexion

Asking the patient to stand on tiptoe

Question 9

What does straight leg raise look for?

Answer 9

Reproduction of neurological pain

You can add in further extension of the foot (sciatic stretch test) or pressure behind the knee (bowstring test)

Question 10

What is the femoral stretch test?

Answer 10

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)

Question 11

Examples of overt pain behaviour?

Answer 11

guarding
bracing
rubbing
grimacing
sighing

Question 12

What scans are used in back pain?

Answer 12

X-rays useless as almost inevitably they will show something

MRI is GOLD STANDARD

Question 13

What is a little white triangle on an MRI?

Answer 13

Annular tear

Question 14

What is sciatica?

Answer 14

Buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

Question 15

What is disc prolapse?

Answer 15

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

Question 16

Is disc prolapse an emergency and why?

Answer 16

NOT an emergency unless caudal equina

70% settle in 3 months
90% settle in 18-24 months

Question 17

When is surgery performed with disc prolapse?

Answer 17

if not resolving after 3 months

long term results the same whether operated or not- surgery just speeds up the natural process

Question 18

Management of backache through conservative treatment

Answer 18

short bed rest only if necessary
anti-inflammatory +- muscle relaxant
mobilise thereafter and return to normal activities

Question 19

What is the initial management of backache in secondary care?

Answer 19

physiotherapy, with an educational and reassurance role

Question 20

One of the problems that can result from back surgery is ASD- what is this?

Answer 20

Adjacent Segment Disease

-Increasing problem

Question 21

What are adverse factors in spinal surgery?

Answer 21

Litigation
Dispute with DSS
Chronic pain syndrome/behaviour

Question 22

Examples of dysfunctional syndromes

Answer 22

Back pain
chronic fatigue syndorme
fibromyalgia
irritable bowel syndrome
migraine/chronic headache
chronic pelvic pain

Question 23

What is the third most common symptom after headache and tiredness in back pain?

Answer 23

co-morbidity

Question 24

define stress

Answer 24

normal emotion in response to life

Question 25

define distress

Answer 25

excess of abnormal stress response