Week 8- Back Pain Flashcards
What are some facts about back pain?
One of the most common complaints in humanity
65-80% have back pain at some point
Most common cause to limit physical activity after age 45
Increases with age
The majority have no pathoanatomic cause
What does the psoas muscle do?
Hip flexion
Hip internal rotation
Hip adduction
Rotate lumbar spine
What leads to shortened psoas muscle?
Sitting
What symptoms favour an inflammatory cause of back pain?
Stiffness worse after sitting or lying, sudden onset of ankle swelling
What are some causes of back pain?
Ankylosing spondylitis
Mechanical back pain (remember most do not have a clear pathoanatomic cause)- lumbar radiculopathy a.k.a sciatica, osteoarthritis
Osteoporotic vertebral fracture
Spinal cord compression, cauda equina syndrome
What are some symptoms of ankylosing spondylitis?
Back pain
Insidious onset
Improved by exercise, worsens with rest
Pain at night
Pain in the buttocks
Hip pain
What are the ways ankylosing spondylitis is treated?
Patient education- exercise and posture training programme
Patient support groups
Stop smoking
Physiotherapy
NSAIDs
What parts of the body can ankylosing spondylitis affect?
Eyes (uveitis)
Shoulders
Gut (IBD)
Sacroiliac joints
Skin (psoriasis)
Knees
Heels
Lumbar Radiculopathy is most commonly due to…
Disc herniation
Spondylosis due to degenerative osteoarthritis
Why can the presentation of Lumbar Radiculopathy vary?
Presentation will vary depending on which nerve root is involved
This is because each nerve root provides sensation to part of the skin (dermatome) and provides innervation to certain muscles (myotome)
What is the most common type of Lumbar Radiculopathy?
L5 Radiculopathy
What are the symptoms of L5 Radiculopathy?
Back pain radiating down the lateral aspect ofthe leg into the foot
Weakness associated with foot dorsiflexion, toe extension, and foot inversion and eversion
How is Lumbar Radiculopathy diagnosed?
It is a clinical diagnosis but need to watch out for other causes or red flags
What are some red flags when a patient presents with back pain?
Progressive or severe motor deficit
Suspected or known cancer (could be due to metastases)
Suspected infection (could be an abscess)
Urinary retention
Urinary or faecal incontinence
Numbness round the anus (saddle anaesthesia), loss of anal sphincter tone
Bilateral symptoms
What is the treatment of radiculopathy?
Exercise- keep active, physiotherapy referral
CBT
NSAIDs
Avoid opiates especially for chronic pain
Where are osteoporotic vertebral fractures most likely?
Lumbar or thoracic spine
How suddenly to osteoporotic vertebral fractures occur?
Can happen acutely or over time
How quickly does pain resolve with an osteoporotic vertebral fracture?
4-6 weeks
What does an osteoporotic vertebral fracture lead to?
Loss of height and may cause kyphosis
What does the treatment for osteoporotic vertebral fractures involve?
Acute treatment-
Analgesia: paracetamol, NSAIDs, short term use of opiates permissible (<4weeks)
Assess for osteoporosis-
DEXA scan
Treatment of suspected osteoporosis-
Adequate calcium and vitamin D, bisphosphonates
What causes cauda equina syndrome?
Central disc protrusion
Malignancy- cancer spread to vertebra and compress lumbosacral nerve roots
Prostate, breast and lung are most common but any malignancy could cause it
What are the symptoms of caudal equina?
Back pain is usually first followed by progressive neurological signs including lower limb weakness, bowel and bladder dysfunction including urinary retention and sensory loss (often less prominent)
What does the treatment of cauda equina syndrome involve?
Cauda equina syndrome is a medical emergency
Urgent referral and MR scan spine
Neurosurgical intervention may be required
