T&O: Mechanical Back Pain Flashcards
Outline the pathophysiology of Mechanical Back Pain.
Nucleus pulposus dehydration = height decreases = load change = marginal osteophytosis = increases surface area but decreases force across spine
Outline the aetiology of mechanical Back Pain.
Age-related degenerative disc
Age-related degenerative facet processes
Muscle or ligament related injuries
Herniated disk = nucleus pulposus
Spinal stenosis = disc spaces decrease as intervertebral discs lose moisture and volume with age
Fibromyalgia
Osteomyelitis
Sacroiliitis
Malignancy
What are the symptoms of Mechanical Back Pain?
Impingement = sharp, well localised, paraesthesia, +ve straight leg sign
Irritation/inflam = dull, poorly localised, without paraesthesia
Herniated disk = radicular pain
Myofascial = loss of motion, pain restricted to a peripheral nerve
How would you investigate a Mechanical Back Pain?
X-ray
MRI
History
Physical examination – lumbar
Straight leg test = result is positive only if the pain radiates to below the knee, this is the single best test for determining radiculopathy due to disc herniation
Abdo exam = exclude intra-abdo pathology
DRE = men older then 50, assess prostate size and exclude prostatitis, CES
Pelvic exam = females complaining of menstrual abnormalities or vaginal discharge
How would you manage Mechanical Back Pain?
Exercise
Weight loss where indicated
NSAIDs = ibuprofen, naproxen
Analgesics = tramadol
Muscle relaxants
Epidural = for pts with herniated disks
Back strengthening exercises = prevent future episodes
Diskectomy
What are the complications of Mechanical Back Pain?
Loss of work due to disability
Weight gain due to inactivity
Depression
Insomnia
Outline how pathology from L4 to S1 present in Mechanical Back Pain.
L4: Pain along the front of the leg, weak extension of the leg at the knee, sensory loss about the knee, loss of knee-jerk reflex.
L5: Pain along the site of the leg, weak dorsiflexion, sensory loss in the web of the big toe, no reflexes lost.
S1: Pain along the back of the leg, weak plantar flexion, sensory loss along the back of the calf and the lateral aspect of the foot, loss of ankle jerk.
L5 and S1: Are involved in approximately 95%of all disc herniations.
What are the current guidelines on x-raying patients with back pain?
NICE = “do not offer x-ray of the lumbar spine for management of non-specific low back pain”
MRI should be considered with a diagnosis of spinal malignancy, infection, fracture, CES, ankylosing spondylitis or another inflam disorder is suspected
What is the role of an MRI scan in the investigation of back and leg pain?
Visualise spinal cord and soft tissues
?cord compression
What is the role of physiotherapy in the treatment of back pain?
Build muscle strength
Posture correction
Relief from pain
What is a root block?
An injection of local anaesthesia and steroid injected under x-ray guidance, into or near a nerve, that serves as a diagnostic and therapeutic tool for pain
Anaesthesia = reduces pain Steroid = reduces infection
What is an epidural?
Injection of local anaesthetic entering the epidural space outside of the dura mater of the spinal cord
