Prolapsed disc and mechanical backache

Question 1

Why should you be wary of a patient who knows the exact date adn time his back pain started?

Answer 1

very unusual for back pain to start with one bad incident, usually creeps up suspiciously- patient may have secondary issues

Question 2

What are the red flag symptoms in a back pain history?

Answer 2

non-mechanical pain
systemic upset
major, new , neurological deficit
saddle anasthesia +/- bladder or bowel upset

Question 3

What are the myotomes that control hip flexion?

Answer 3

L1/2

Question 4

What are the myotomes that control L3/4?

Answer 4

knee extension

Question 5

What are the myotomes that control foot dorsiflexion and EHL?

Answer 5

L5

Question 6

What myotomes control ankle plantarflexion?

Answer 6

S1/2

Question 7

What is the test to test plantar reflexes?

Answer 7

babinski

Question 8

How useful are walking aids in back pain?

Answer 8

walking aids do not help back pain

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Question 9

What are examples of overt pain behaviour?

Answer 9

guarding; bracing; rubbing; grimacing; sighing

Question 10

What are behaviourla responses seen with chronic pain?

Answer 10

tests which do not cause additional stress on the spine but patients respon to

Question 11

What are examples of bevioural responses?

Answer 11

superficial/non-anatoical tenderness’ simulation- axial loading/ roataion
distraction
over-reaction to exam
regional- sensory distubrance, giving way

Question 12

/what is distraction SLR?

Answer 12

When a patient can sit up to 90 degrees with legs straight out but cant stright leg raise much

Question 13

What is the gold standrard investigation with back pain?

Answer 13

MRI

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 the common presentation of disc proleapse?

Answer 15

episodic back pain; onset of leg pain +/- neurology; leg pain becomes dominant

Question 16

Why should surgery not be undertaken within 3 months of onset of symptoms of disc prolapse?

Answer 16

70% of cases will settle within 3 months

Question 17

When is disc prolapse an emergency?

Answer 17

cauda equina syndrom

Question 18

What is conservative management of backache?

Answer 18

short bes rest (debatable); anti-inflam +/- muscle relaxant; mobilise thereafter; physical therapies; return to normal activity

Question 19

What is the aim for back pain management?

Answer 19

ideal is fast, active rehab; reassurance; rapid return to work

Question 20

What is the problem with surgery in adjacent segment disease?

Answer 20

tends to just push the problem further up after fusion

Question 21

What happens during chronic pain syndrome?

Answer 21

central pain perception is squeed

Question 22

What are behavioural symptoms?

Answer 22

pain at tp of coccyx; whole leg pain/numbness/giving way; absnce of pain ree spells; intolerance of treatment; emergenc admission

Question 23

What should you note in patinets who have behavioural symptoms?

Answer 23

typidcally wont respond to physical help- need to collaborate with MDT

Question 24

What is the importance of a stress history?

Answer 24

there is increasing evidence of link between chronic pain and childhood abuse

Question 25

What are the psychosocail yellow flags?

Answer 25

belief that back pain is harmful or potentially seriously disabling; fear avoidance behaviour; low mood/ withdrawal; passive rather than active