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Ortho/Rheumatology > Spinal Disorders/Back Pain > Flashcards

Spinal Disorders/Back Pain Flashcards

1
Q

What is the 3rd leading reason for medical visits?

A

Back pain.

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2
Q

What is the MC cause for worker disability under the age of 45?

A

Back pain.

**Lifetime prevalence of 85%

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3
Q

What is very important to ask about a pt’s HPI of back pain?

A

Does the pain radiate??

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4
Q

What are some aggravating factors of associated with back pain?

A
  1. Sitting (related to disc herniation, pinching of nerve).
  2. Weight bearing (more hip pathology).
  3. Walking
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5
Q

What is important to remember about the timing of a pt’s back pain?

A

-Nighttime Pain?? *worrisome for malignancy.

  • Early morning pain? RA, other autoimmune, OA.
  • -How long does that morning pain last? RA longer (>1hr) needs a warming up period vs OA (10-15 mins).
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6
Q

Severity of back pain?

A
  • Pain scale of 0-10.
  • What’s worse….back pain or the radiating leg pain?
  • Function…what CAN’t you do?
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7
Q

Why is it important to have your pt describe their back pain?

A
  1. Benign back pain is often “aching” or “burning.”
  2. Pathological back pain or non-spinal causes:
    - PANCREATITIS = “Burning or piercing” mid-back pain w/elevated amylase, lipase.
  • AORTIC DISSECTION = “Tearing” chest and mid-back pain; a surgical emergency.”
  • NEPHROLITHIASIS = Lumbar pain radiates to groin, “Colicky.” Hematuria, Renal CT.
  • PYELONEPHRITIS = Flank pain, provoked by percussion at CVA. Dysuria, Pyuria.
  • AUTOIMMUNE, INFLAMMATORY = Back and multiple involvement. Elevated ESR, ANA.
  • FIBROMYALGIA = painful trigger points throughout the body.
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8
Q

Other factors to consider with a complaint of back pain?

A
  • Paresthesias = numbness, tingling, pins/needles, etc.
  • Weakness = full body or specific area.
  • Urinary incontinence = sacral nerve.
  • Saddle anesthesia = sacral nerve.
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9
Q

Making the diagnosis based on history…

A
  1. Sciatica = disc herniation, spondylolisthesis.
  2. Trauma w/local back pain = compression fracture.
  3. Leg pain worse standing/walking = spinal stenosis, neurogenic claudication.
  4. IV Drug user = spinal abscess, discitis, osteomyelitis.
  5. Work injury, Insurance settlement = Malingering (diagnosis of exclusion).
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10
Q

Innervation of Hip flexion?

A

L1, L2.

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11
Q

Innervation of knee extension?

A

L3, L4.

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12
Q

Innervation of Dorsiflexion?

A

L4.

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13
Q

5 important things to check on the strength examination of a pt with complaints of back pain?

A
  1. Hip flexion (L2, L3).
  2. Knee extension (L3, L4).
  3. Dorsiflexion (L4).
  4. Extensor Hallucis Longus (L5).
  5. Plantar-flexion (S1).
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14
Q

Innervation of Extensor Hallucis Longus?

A

L5.

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15
Q

Innervation of Plantar-flexion?

A

S1.

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16
Q

PE topics to focus on when a pt complains of lower back pain?

A
  1. Inspection.
  2. Palpation.
  3. Strength and grading.
  4. ROM.
  5. Gait.
  6. Sensation.
  7. DTRs.
  8. Special Techniques.
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17
Q

Identify the Special Tests:

  1. Straight leg raising test.
  2. Crossed or Contralateral Straight Leg Raising Test.
  3. Internal/External Hip Rotation.
A
  1. To determine if a patient w/low back pain has an associated nerve root irritation or entrapment; such as the sciatic nerve.
  2. Straight leg raising test of the unaffected side; if Sx reproduced…highly associated with herniated disc and sciatic radiculopathy (about 97% of the time).
  3. Will identify if the pain is coming from the hip.
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18
Q

Back pain that affects muscles/tendons/ligaments and associated with a single or multiple traumatic events?

A

Lumbar Strain.

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19
Q

Prevalence and causes of Lumbar strain?

A
  1. Very common; 70% of back pain diagnoses.

2. Trauma, OBESITY, poor muscle tone, poor lifting technique, high heels, deconditioning.

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20
Q

Presentation of Lumbar Strain?

A
  1. Back pain.

2. NO radicular symptoms.

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21
Q

What are radicular symptoms?

A

Radiating pain that follows a dermatome.

**Memorize your dermatomes.

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22
Q

LOSS OF DISC HEIGHT with bone spur formation and thickened ligaments caused by aging and repetitive trauma?

A

Degenerative Disc Disease (DDD).

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23
Q

Prevalence of DDD?

A
  • Very common.
  • Age 45+.
  • Female > Male.
  • Obesity.

**Also the same for Facet Syndrome.

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24
Q

Presentation of DDD?

A

Back pain with stiffness, sore back, no radiation.

Complaint of “back went out.”

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25
Q

Continuation or 2/2 to DDD of spine?

A

Facet Syndrome.

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26
Q

Patho of Facet Syndrome?

A
  • *Loss of disc space height (DDD):
  • -Increased load on facet joints.
  • -Increased wear on articular cartilage.
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27
Q

Presentation of Facet Syndrome?

A
  1. Chronic LBP not responsive to traditional mgmt.

2. May have increased pain w/side bending.

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28
Q

Protrusion or Extrusion of a intervertebral disc? What can happen with this condition?

A

Herniated Disc can cause compression of a spinal nerve.

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29
Q

Most common location (not vertebral level) of a herniated disc?

A

Paracentral location is MC; lateral disc herniation can happen.

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30
Q

Presentation of herniated disc?

A
  1. Pain, paresthesias, weakness.
  2. In the distribution of a spinal nerve (dermatome).
  3. Worse sitting, better standing.
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31
Q

Narrowing of the spinal canal?

A

Spinal stenosis.

**Compresses the spinal nerves.

32
Q

Emergency complication of Spinal Stenosis?

A

Compressing of the Cauda Equina (Cauda Equina Syndrome).

33
Q

Presentation of Spinal Stenosis?

A
  1. Pain, paresthesias of legs with lack of stamina in legs.
  2. WORSE STANDING OR WALKING, BETTER SITTING.
  3. Neurogenic Claudication.
34
Q

Where does the spinal cord end?

A

at the level of L1 or L2.

35
Q

What vertebral levels is the cauda equina located?

A

L1-L5.

36
Q

What is another name for neurogenic claudication and what is it?

A

Pseudoclaudication; compression of the nerves in the lumber region causing leg pain, more specifically, difficulty or weakness with walking.

37
Q

Why is pain worse with standing or walking and better with sitting in Spinal Stenosis?

A

When you sit, the SC opens up. When you sit, the SC narrows.

38
Q

Compression of the cauda equina?

A

Cauda Equina Syndrome.

**A surgical emergency!!!

39
Q

What causes Cauda Equina Syndrome?

A
  • Spinal Malignancy.
  • Vertebral Fracture.
  • Disc Herniation.
  • Spinal Stenosis.

**Anything that can compress the cauda equina.

40
Q

Presentation of Cauda Equina Syndrome?

A
  1. Low back pain that is very severe.
  2. Saddle anesthesia.
  3. Urinary incontinence.
  4. Impotence.
41
Q

Why do the symptoms of Cauda Equina manifest?

A

The cauda equina houses the sacral plexus (S1-S4) which innervate the pelvic muscles, perineum and organs in the pelvis.

42
Q

A “slip” of one vertebra with respect to another?

A

Spondylolisthesis.

43
Q

What is the cause of Spondylolisthesis…aka the “slip” and what may it cause?

A

A fracture of the pars interarticularis.

It may cause Spinal Stenosis or pinch a spinal nerve.

44
Q

What is the pars interarticularis?

A

Also ‘pars’ for short, is the part of a vertebra located between the inferior and superior articular processes of the facet joint.

It is an area most stressed by translational movement between the adjacent segment.

45
Q

Presentation of Spondylolisthesis?

A
  1. Local low back pain.
  2. Better lying.
  3. With or without radiculopathy or neurogenic claudication.

**More of a bony back pain.

46
Q

An abnormal curvature of the spine in the coronal plane?

A

Scoliosis.

47
Q

What may also be associated with Scoliosis?

A

Abnormal sagittal kyphosis – Kyphoscoliosis.

*Abnormal curvature of the spine in two planes; the coronal plane (side to side) and the sagittal plane (back to front).

48
Q

Presentation of Scoliosis?

A
  1. Back pain.
  2. Rotation of rib cage.
  3. Uneven hips.
49
Q

What is the Cobb Angle?

A

The measurement of the degree of side-to-side spinal curvature.

50
Q

What is an infection of the intervertebral disc?

A

Discitis.

51
Q

What may extend to the body of the vertebra from Discitis?

A

Vertebral Osteomyelitis – infection of the bone.

52
Q

Who is Discitis and Osteomyelitis common in?

A

Diabetics and IV Drug users.

53
Q

Presentation of Discitis and Vertebral Osteomyelitis.

A
  1. Severe back pain.
  2. Malaise.
  3. Ill-appearing.
  4. May have a fever.
54
Q

The collapse of the body of a vertebra, thoracic and upper lumbar?

A

Vertebral fracture.

55
Q

What are the causes of a Vertebral Fracture?

A
  1. Traumatic - severe MOI.

2. Pathological – Osteoporosis, malignancy.

56
Q

Presentation of Vertebral Fracture?

A
  1. History of trauma – is it severe enough to cause this Fx?
  2. Back pain.
  3. May have Sx of compression of a spinal nerve, spinal cord, or cauda equina.
57
Q

The vast majority of low back complaints arise from what vertebral level?

A

L4-S1 (L4/5, L5/S1).

58
Q

Disc L1-2…nerve, pain, radiation, reflex, muscle?

A

L1-L2:

  1. Nerve = L2.
  2. Pain = lower back pain.
  3. Radiation = groin, medial thigh.
  4. Reflex = none.
  5. Muscle = none.
59
Q

Disc L2-3…nerve, pain, radiation, reflex, muscle?

A
  1. Nerve = L3.
  2. Pain = lower back pain.
  3. Radiation = antero-medial thigh.
  4. Reflex = none.
  5. Muscle = hip flexors (iliopsoas).
60
Q

Disc L3-4…nerve, pain, radiation, reflex, muscle?

A
  1. Nerve = L4
  2. Pain = lower back pain.
  3. Radiation = anterior thigh patella.
  4. Reflex = KNEE.
  5. Muscle = knee ext…Quadriceps.
61
Q

Disc L4-5…nerve, pain, radiation, reflex, muscle?

A
  1. Nerve = L5.
  2. Pain = lower back pain.
  3. Radiation = lateral thigh, lateral calf, dorsum of foot
  4. Reflex = none.
  5. Muscle = Great toe…Extensor Hallucis Longus (EHL).
62
Q

Disc L5-S1…nerve, pain, radiation, reflex, muscle?

A
  1. Nerve = S1
  2. Pain = lower back pain.
  3. Radiation = Lat. thigh, lat. calf, lat. foot.
  4. Reflex = ANKLE.
  5. Muscle = Plantar flexors…Gastrocnemius.
63
Q

Spinal imaging diagnostic for Back Pain?

A
  1. XR.
  2. CT Scan (non-contrast).
  3. MRI.
  4. Myelogram w/post-myelogram CT Scan.
64
Q

Indications and views for L-Spine XR?

A

Indications:
-Trauma, back pain w/Hx of malignancy, back pain over a month.

Views:
-AP, Lateral, Oblique, Flexion/Extension.

65
Q

Why is a Flexion/Extension view necessary on L-Spine XR?

A

To assess for the stability of a ‘Slip’ of a vertebra.

66
Q

Indications and views for Non-Contrast CT Scan?

A

Indications:
-Trauma, Vertebral Fx, Eval of Lytic Lesions.

Views:
-Axial, Sagittal, Coronal.

67
Q

What is the ‘Go-To’ imaging for Radicular pain?

A

MRI.

68
Q

Indications, views and contraindications of MRI?

A

Indications:
-Radicular pain, Neurogenic claudication, Cauda Equina Syndrome (Stat MRI), New back pain w/Hx of malignancy.

Views:
-Axial, Sagittal, Coronal.

Contraindications:
-Pacemaker, neurostimulators.

69
Q

Who is a Myelogram indicated for?

A

Those that have a contraindication for MRI.

70
Q

Indications and views of Myelogram w/Post-Myelogram CT?

A

Indications:
-Neural compression, vertebral Fx, OK for pacemakers and neurostimulators.

Views:
-Myelogram, CT Post Myelogram.

71
Q

How is the iodinated contrast injected?

A

Intrathecal.

72
Q

Treatment of Back Pain?

A
  1. Injury Prevention.
  2. Home Interventions.
  3. Physical Therapy (PT) - massage, TENS unit, active exercises.
  4. Chiropractic - Spinal manipulation.
  5. Acupuncture.
  6. Medications.
  7. Referrals.
73
Q

Examples of Injury Prevention and Home interventions for treating back pain?

A

Injury Prevention:
-Core strength, proper lifting techniques, ergonomic work stations.

Home Interventions:

  • Rest 1-2 days.
  • ICE in acute phase, then heat.
  • Gradual return to normal activities.
  • Avoid prolonged work/school excuse.
  • Support brace (little role).
74
Q

Examples of medications for treatment of back pain?

A
  1. NSAIDs or Acetaminophen.
  2. Narcotics (acute phase only).
  3. Muscle relaxants (acute phase only).
  4. Antidepressants (improve pain threshold).
  5. Anticonvulsants (improve painful paresthesias).
75
Q

Examples of referrals for treatment of back pain?

A
  1. ER for surgical consultation…Cauda Equina Syndrome.
  2. PT…back pain >1 month.
  3. Ortho- or Neurosurgery (leg pain worse than back pain).

Ortho/Rheumatology (15 decks)

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