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MSK/Derm > SM 237: Back Pain > Flashcards

SM 237: Back Pain Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the Socioeconomic impact of lower back pain?

A

3rd most common reason for primary care visit and most common cause of disability for patients under 45

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2
Q

What are potential pain generators in the lower back?

A

Vertebral bodies, intervertebral discs, zygopophysial/facet joints, ligaments, nerves, muscles, sacroiliac joints

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3
Q

Where in the lower back does most motion occur?

A

L4-L5 and L5-S1

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4
Q

How does vertebral canal size change with flexion and extension?

A

Extension decreases and flexion increases in the lower back

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5
Q

How does facet load change with extension and flexion?

A

Facet loads increase with extension and decrease with flexion in the lower back

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6
Q

What lowers pressure on intervertebral discs?

A

Lying down on your side or back

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7
Q

What raises pressure on intervertebral discs?

A

Bending forward, sitting, and sitting in bad posture - also the valsalva maneuver

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8
Q

What causes discogenic lower back pain?

A

Pain caused by an intervertebral disc, due to irritation of nerve receptors innervating the annulus fibrosus and periosteum

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9
Q

Why does pressure on a disc lead to tears?

A

The nucleus pulposis inside a disc is incompressible and leads to tears of the annulus fibrosus

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10
Q

What is disc herniation?

A

Nucleus pulposus leaks out of the annulus pulposis and into the intervertebral disc space

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11
Q

Where are disc herniations most common?

A

L4-L5, and L5-S1

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12
Q

Can disc herniations happen acutely?

A

Yes, but they can also be chronic

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13
Q

What is Lumbar radiculopathy?

A

Pain that radiates down a leg in a dermatomal distribution due to nerve root compression and inflammation, with sensory and/or muscle weakness in the same dermatomal weakness

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14
Q

How does lumbar radiculopathy effect neurological findings?

A

Sensory symptoms, muscle weakness in a dermatome and abnormal reflexes

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15
Q

What are zygopophysial joints?

A

Synovial joints where vertebrae interlock that can experience degenerative changes leading to joint pain

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16
Q

What movement worsens lower back pain due to zygopophysial joints?

A

Zygapophysial joint-driven back pain worsens with extension, especially at the more mobile levels of the lower back L4/5 and L5/S1

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17
Q

What imaging findings are consistent with Zygopophyial joint driven back pain?

A

None, imaging can vary if the Zygopophysial joint is causing lower back pain

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18
Q

What is spinal stenosis?

A

A common source of pain and disability in the elderly population due to narrowing of the spinal canal

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19
Q

How does prolonged walking effect vertebral size?

A

Prolonged walking causes extension, decreasing vertebral canal size

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20
Q

What does “neurogenic claudication” refer to?

A

Leg pain with walking, prolonged standing, and downhill walking due to compression of the vertebral canal, releived by actions that induce flexion

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21
Q

What is the “shopping cart sign”?

A

Found in spinal stenosis, relieves pain due to flexion increasing size of the vertebral canal

22
Q

How do muscles cause lower back pain?

A

Muscle itself may be strained or torn, or the muscle pain is secondary due to a disc injury or an irritated nerve

23
Q

What should a history for lower back pain cover?

A

Ask about a mechanism for a specific event, ask for alleviating or aggravating factors, ask about radiation/tingling/numbness/weakness and bower/bladder symptoms

24
Q

What are the specific alleviating or aggravating factors to ask about in lower back pain?

A

Positional stuff:

flexion vs extension
sitting vs standing
transitional pain
coughing, sneezing

25
Q

Why do we ask about bower/bladder symptoms in lower back pain?

A

Red flag symptoms indicating a CNS emergency

26
Q

What biopsychosocial factors can contribute to lower back pain?

A

Depression, anxiety, stress as well as attitude and fear-avoidance behaviors due to chronic back pain

27
Q

What should physical examinations cover in lower back pain?

A

Inspect in shorts, palpate bony and soft tissue structures, range of motion, neurological exam for radiculopathy, and neurodynamic testing

28
Q

What are neurodynamic tests?

A

Dural tensions signs that assess for nerve root issues possibly due to compression: straight leg raise, slump sit test, femoral nerve stretch

29
Q

What joint should be evaluated in lower back pain and why?

A

The Hip and spine joints, with focus on range of motion, because the back can refer pain to the hip and the hip can refer to the back/buttocks

30
Q

Is imaging necessary for lower back pain?

A

Not for the first 6 weeks, because radiographic findings do not correlate with clinical severity or outcome, and some patients have radiographic findings with no symptoms

31
Q

When should you order imaging in lower back pain?

A

If pain doesn’t respond to treatment, suspected fracture, neurologic defects, vertebral infection or cancer

32
Q

What imaging test is used for lower back pain and what are you looking for?

A

Often use Xray, and look for fractures, alignment/spondylolisthesis/vertebral slipping, and disc height loss

33
Q

What does MRI look for in lower back pain?

A

Internal disruption of disc, Z-joing arthropathy, central or foraminal narrowing for nerve impingement, and fracture or infection

34
Q

What is the prognosis for lower back pain?

A

Most people improve in a week and up to 90% improve in the first 12 weeks; but pain may relapse and pain can become persistent

35
Q

What satisfies the patients most in lower back pain?

A

Patients who are given the best explanation of the problem causing their lower back pain

36
Q

How is lower back pain treated acutely?

A

Decrease pain/inflammation with PT and NSAIDS
Early mobilization
Directional movement pattern to centralize pain

37
Q

What are the active modalities to treat lower back pain?

A

Activity modification, lumbar stabilization, aquatic exercises

38
Q

Does lower back pain improve with bedrest?

A

Nope

39
Q

Why don’t we give every patient the same exercise program to patients with lower back non?

A

Non-specific treatment for a non-specific problems leads to poor outcomes

40
Q

What characterizes subgroups of traetment?

A

Location, anatomic structure involved, and directional preferences

41
Q

What is directional preference?

A

A movement in a specific direction that removes pain from limbs and centralizes the pain to the back, allowing for pain-free motion, with very patient-specific treatments

42
Q

Is flexibility at the back or hip/knee most important to prevent lower back pain?

A

Flexibility at the hip/knee and stability in the back are better at preventing lower back pain

43
Q

How do core stabilizaiton exercises treat lower back pain?

A

They maintain spinal stability and help oppose the movements of limbs, works better than non-specific exercise

44
Q

Does walking benefit lower back pain?

A

Yes

45
Q

What spinal injections treat lower back pain?

A

Epidural injections for radicular pain, facet injections for facet mediated pain and medial branch blocks/ablation

46
Q

How are spinal injections performed, and with or without contrast?

A

Fluoroscopic guidance with contrast to avoid penetrating unwanted structures like vasculature

47
Q

When should someone be referred to surgery for lower back pain?

A

Cauda equina symptoms, progressive neurologic deficit, and suspected spinal cord compression; or if every non-surgical option has failed

48
Q

What is Cauda equina syndrome?

A

Saddle anesthesia, bladder dysfunction, and bilateral leak weakness due to compression of the Cauda equina

49
Q

What is Cauda equina syndrome?

A

Saddle anesthesia, bladder dysfunction, and bilateral leak weakness due to compression of the Cauda equina

50
Q

What is the difference between radiculopathy and radicular pain?

A

Radicular pain has no abnormal sensory or motor reflexes or muscle issues, just pain that radiates down the leg; radiculopathy implies pain + sensory and motor deficits

MSK/Derm (46 decks)

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