Week 1 - Hx taking for spinal conditions

Question 1

List the diagnostic triage

Answer 1

• Specific pathology (incl. serious path.)
• Spinal n./n. root involvement
• Non-specific spinal pain

Question 2

What are red flags?

Answer 2

• Signs of possible serious path.
• <20, >50yrs
• trauma
• unwell
  recent unexlplained weight loss
• structural deformity
• Hx of Ca, steroids, drug abuse, HIV
• constant pain
• non-mechanical pain
• S&S inflammatory disorders
• family Hx of inflammatory diorders

Question 3

What are signs of Spinal n./n. root involvement?

Answer 3

• Radicular pain

* Radiculopathy

Question 4

What is Radicular pain?

Answer 4

• Irritation of a spinal n. or n. root
• shooting and band-like in character
• oft. caused by inflammation in response to nuclear disc material of mechanical compression

Question 5

What is radiculopathy?

Answer 5

• conduction is blocked in axons of spinal n. or n. root

Question 6

What can cause radiculopathy?

Answer 6

• disc herniation or foraminal stenosis

* compression or ischaemia

Question 7

What are symptoms of radiculopathy?

Answer 7

• Numbness, weakness, reduced reflex

Question 8

Is pain localised to low back or neck region due to somatic or radicular pain?

Answer 8

Somatic

Question 9

Does radicular pain mean the patient has compression of a n. root?

Answer 9

No, because radicular pain is irritation. Compression of n. root would cause radiculopathy

Question 10

Is somatic or radicular pain more common?

Answer 10

Somatic

Question 11

How do you identify radiculopathy?

Answer 11

Neuro. exam

Question 12

What should be included in cHx?

Answer 12

• Duration (acute/recurrent/chronic)
• course since onset
• MOI
• trauma
• non-traumatic
• Possible impairment/mechanisms: m. weakness/control, stiffness, posture/technique, fear of movement
• pt.’s understanding of what is causing their pain

Question 13

What should special questions cover?

Answer 13

• SC involvement
• ataxia, unsteady gait, bilateral (non-dermal) symptoms
• Cauda equina (L/sp)
• loss of bladder and sphincter control
• urinary retention (emergency)
• sensory loss in saddle region
• inflammatory cond.
• serious pathologies
• vertebral a. insufficiency

Question 14

What are yellow flags?

Answer 14

• older age
• more intense pain
• longer duration of LBP
• more days of reduced activity
• Pt. reports feeling depressed
• Pt. believes pain is likely to persist
• compensable LBP

Question 15

What are specific pathologies?

Answer 15

• fractures
• structural damage
• serious pathologies (i.e. tumour, infection, inflammatory disease, cauda equina)
• <1%

Question 16

What is non-specifc spinal pain?

Answer 16

• has many symptoms

* diagnosis of exclusion