Ross - Back Pain Flashcards
__% of people have back pain in their life
__% of people have emergent back pain
85%
3%
5 serious causes of back pain
cauda equina
cord impingement
AAA or dissection
pathological features
osteomyelitis
what are 3 causes of cord impingement
herniated disc
epidural abscess
epidural hematoma
spinal cord impingement findings are often
unilateral
pt’s that are high risk for emergent back pain
immunocompromised
etoh
ivdu
steroid users
DM
HIV
3 symptoms related to increased risk for emergent back pain
increasing chronic pain
nighttime pain
radicular pain
PMH indicative of high risk for emergent back pain (4)
multiple visits
hx trauma
hx back surgery
fever
what might the previous pt’s need
emergent MRI
what imaging to order if you suspect fx w. back pain
CT
do most ppl need imaging/labs for back pain
no!
tx for non most non emergent back pain
stay OUT of bed
ibuprofen
indications to return
what is spondylosis
nonspecific, degenerative dz
what is spondylosis
nonspecific, degenerative dz
what is spondylolysis
fx of pars
what is the pars (interarticularis)
part of vertebrae between inferior and superior articular processes of facet joint
what is spondylolisthesis
fractured pars (spondylolysis) interarticularis separates → injured vertebrae slips anterior
what nerve roots are involved in 95% of all disc herniations
L5
S1
what nerve root:
pain along the front of the leg, weak extension of leg at knee joint, sensory loss about the knee, loss of knee-jerk reflex
L4
what nerve root: pain along the side of the leg, weak dorsiflexion of foot, sensory loss in web of big toe
L5
what nerve root: pain along back of leg, weak plantarflexion of foot, sensory loss along back of calf and lateral aspect of foot, loss of ankle jerk
S1
the CMT for non-traumatic back pain determines whether a pt needs (3)
MRI w. contrast
ESR
avoidance of MRI and other imaging
minor criteria for CMT for non-traumatic low-back pain (5)
etoh abuse
DM
renal failure
night pain
3rd visit in last 20 days
→ 1 point each
major criteria for CMT for non traumatic low-back pain (7)
iv drug use
fever w.o focus
recent/current systemic infxn
immunosuppression
recent spinal fx/procedure
incontinence/retention
indwelling urinary catheter
→ 3 points each
__ points or more on the CMT for non-traumatic back pain requires an ESR
4
a CMT for non-traumatic back pain <4 means you should
consider avoiding MRI and other imaging
herniated discs usually affect people in their __ decade of life
3rd → 20-29 yo
herniated discs usually occur between (2)
L4/L5
L5/S1
how do herniated discs present
abrupt onset of pain
unilateral
aggravated by walking, standing, coughing
persistent pain
how do you diagnose herniated disc
MRI
tx for herniated disc is __ at first,
but may need __ if pain persists
surgery → remove pressure from root
indication for emergent surgery for herniated disc
motor finding of weakness
__ symptoms in herniated disc may be repaired less emergently
sensory
what test might be positive in herniated disc
straight leg
__ is a catch all term for lower back pain
sciatica
cauda equina syndrome affects which nerve root pairs
L2 - S5
the cauda equina extends from __
to __
L1 - Co1
cauda equina syndrome occurs when there is a
compression → reduction of volume for spinal roots
4 causes of cauda equina
disc herniation
spinal abscess
hematoma
fx
typical presentation of cauda equina syndrome
bilateral radicular pain
leg weakness w. difficulty walking on toes/heels
urinary/stool incontinence → loss of sphincter control
what is a very sensitive test for cauda equina syndrome
urinary sphincter control test
urinary sphincter test > __ is positive
150
if a post void residual test is positive you should,
order MRI emergently
what 2 pt’s with back pain need xrays for sure
65 yo or older
pt’s w. red flags
what type of imaging do pt’s w. red flags need
emergent
tx for acute back pain (5)
education
muscle relaxants
NSAIDs
early exercise
PT
are narcotics ok for acute back pain?
short dose is ok
look pt up in data base
tx for chronic back pain (3)
PT
NSAIDs
neuropathic pain meds
name 2 neuropathic pain meds
TCAs
gabapentin
