Sciatica and back pain

Question 1

Red flags for lower back pain

Answer 1

• age < 20 years or > 50 years
• history of previous malignancy
• night pain, history of trauma
• systemically unwell e.g. weight loss, fever

Question 2

What are the features of facet joint pain?

Answer 2

Pain worse in the morning and on standing

On examination there may be pain over the facets. The pain is typically worse on extension of the back

Question 3

Spinal stenosis

Answer 3

Narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine.

Question 4

Features of spinal stenosis

Answer 4

Usually gradual onset
Relieved by sitting down, leaning forwards, and crouching down
Clinical examination is often normal

Question 5

What is Ankylosing spondylitis?

Answer 5

Inflammatory arthritis that, over time, can cause some of the bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched posture. If ribs are affected, it can be difficult to breathe deeply.

Question 6

Features of Ankylosing spondylitis

Answer 6

Typically a young man who presents with lower back pain and stiffness
Stiffness is usually worse in morning and improves with activity
Peripheral arthritis (25%, more common if female)

Question 7

Features of peripheral arterial disease

Answer 7

Pain on walking, relieved by rest

Absent or weak foot pulses and other signs of limb ischaemia

Question 8

Sciatica

Answer 8

pain felt along the sciatic nerve, which runs from your lower back, down through the buttock, hamstrings and into the lower leg.

Question 9

Causes of sciatica

Answer 9

Herniated or slipped disk
Degenerative disk disease
Spinal stenosis
Spondylolisthesis
Osteoarthritis
Tumours, trauma