T&O - Back Pain Flashcards

1
Q

What is mechanical back pain?

A

• Soft tissue injury, muscle spasm and pain, may have inciting event (lifting)

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2
Q

What is the conservative and medical Mx for mechanical back pain?

A

Conservative:

  • Max 2day bed rest
  • Physio, warmth

Medical:

  • Analgesia: paracetamol + NSAIDS + codeine
  • Muscle relaxant: low dose diazepam
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3
Q

What is a disc prolapse?

A

herniation of nucleus pulposus through annulus fibrosus

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4
Q

Describe a typical presentation of disc prolapse

A
  • L5/S1 most commonly compressed by prolapse of L4/L5 and L5/S1 discs
  • Severe back pain on sneeze/cough
  • Lumbago: lower back pain
  • Sciatica: shooting radical air pain down buttock/thigh
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5
Q

What type of neuropathy do you get in lateral vs central herniation?

A

-Lateral herniation = radiculopathy vs central herniation = cauda equina syndrome (after L1/L2)

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6
Q

What symptoms will you get in L4/L5 root compression? Which root is affected?

A

L5 root compression

  • Weak hallucinations extension +/- foot drop
  • Decreased sensation in dorsum of foot
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7
Q

What symptoms do you get in L5/S1 root compression? Which root is affected?

A

S1 root compression

  • Weak foot plantarflexion and eversion
  • Loss of ankle jerk
  • Calf pain
  • Decreased sensation over sole of foot and back of calf
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8
Q

What Ix should you conduct in someone with back pain?

A
  • Vitamin D, FBC, U&E, CRP, bone profiles (Ca, albumin, phosphate, ALP), LFT (if bony mets, might have mets there or ALP problems), ESR, LDH (raised in bone marrow cancers), Myeloma screen in older pts (Bens-John’s protein in urine, Beta2 microglobulin in blood and serum electrophoresis)
  • X-RAY
  • MRI (emergency if cauda equina is suspected)
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9
Q

What is the conservative, medical and surgical Rx for disc prolapse?

A
  • Brief rest, analgesia and mobilisation - pt cannot spend many days in bed
  • Conservative: rest, mobilisation and physio
  • Medical: analgesia/transformational steroid injection
  • Surgical: discectomy or laminectomy may be needed in cauda equina/continuing pain/muscle weakness
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10
Q

What is spondylolisthesis?

A

-Definition: displacement of one lumbar vertebra on another - usually in fracture of pars intereticularis (usually forward and L5 on S1)

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11
Q

What are the causes of spondylolisthesis? Presentation? Dx? Rx?

A
  • Congenital malformation, spondylosis (degeneration of intervertebral discs) and OA
  • Presentation: onset of pain usually worse on standing, +/- sciatica/hamstring tightness and abnormal gait
  • Dx: made with plain radiography
  • Rx: corset, nerve release or spinal fusion
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12
Q

What is spinal stenosis?

A

-Definition: developmental predisposition +/- face joint OA leading to generalised narrowing of lumbar spinal canal

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13
Q

What is the typical presentation of a pt with spinal stenosis?

A

Presentation

  • Spinal claudication: aching or heave buttock/lower limb pain on walking, rapid onset, may have associated parasthesia/numbness, pain eased by leaning forward
  • Pain on spine in extension
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14
Q

Spinal stenosis: Ix and Rx

A
  • Ix: MRI

* Rx: corsets, NSAIDs, epidural steroid injection, canal decompression

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15
Q

Neurosurgical emergencies: acute cord compression - presentation

A
  • Bilateral pain: back and radical are
  • LMN signs at compression level
  • UMN signs and sensory below compression
  • Sphincter disturbance
  • Call for help!
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16
Q

Neurosurgical emergencies: Acute caudal equina compression - presentation and Rx

A

Presentation:

  • Alternative/bilateral radicular pain in legs
  • Saddle anaesthesia
  • Loss of anal tone
  • Bladder +/- incontinence

Rx: cause dependant

  • Large prolapse: laminectomy/discectomy
  • Tumours: radiotherapy and steroids
  • Abscesses: decompression