Wk 4 Flashcards
Describe the types of back pain
Vasc: aortic aneurysm Infx: diskitis Neo: mets D Idio: non specific C Anatomic: disc disease T E
Describe your approach to hyponatremia
Ball
What are occupational influences that okay a role in the etiology of back pain?
Whole body vibration forward bending amid twisting manual handling of materials.... HEAVY LIFTING NOT as much of issue as the handling. poor psychosocial conditions freq heavy lifting.
What are modifiable risk factors in back pain?
Lack of fitness Poor health Obesity Smoking Drug dependence
Rate of lower back pain decreases after age 50. Why?
Dec activity.
- less rigorous.
People start to retire.
Dec complaining
Back pain women experience is less likely what etiology as compared to men?
Women experience more back pain but less commonly the cause is herniated discs.
What are factors that have little or no association with back pain?
Height and weight
Aerobic activity
Absolute strength (whereas relative strength is a risk factor…. Usually it is the big muscular guys that get it)
Distinguish the difference btwn mechanical and compressive back pain?
Mechanical is characterized by:
inflammation, irritation or injury to disc facet joints, ligaments or muscles to back.
Important notes: pain NEVER behind knee. Might go to back and buttocks but localized to there.
Compressive: occurs when nerve root leaving spine is irritated or pinched.
Anatomic: commonly due to herniated disc
Most common cause of mechanical back pain?
degen: age related degenerative disc disease.
ANATOMIC: facet processes; muscle/ ligament.
RFs
History of prev back pain and / or injury.
What are waddells signs?
These are non organic signs that don't make anatomic sense. - look for other signs of pain! -not necessarily malingering!! Not a lie detector Superficial tenderness Non anatomic tenderness Axial loading Simulated rotation Distracted straight leg raise Regional sensory changes Regional weakness Overreaction
How clinically significant is a disc bulge?
Most have no clinical significance. We prob all have it.
Protrusion and extrusion are more pertinent and can lead to the neurological compromise.
How to triage low back pain according to CLIP practice guidelines?
I) simple back pain
- lumbo or lumbrosacral with no neuro impairment
- mechanical… Varies over time and w activity.
General health is good. - imaging is low-yield.
- can do spinal xray to r/o spinal pathology.
II) back pain w neuro impairment.
> or = s and s
- pain below knee that is as or more intense than back pain.
- pain rads to foot or toes. + for radic irritation (straight leg)
- numbness or parasthesia in the painful area.
- pw exam: sens, motor, reflex.
- xray sufficient to exclude spinal pathology.
III) back pain w suspected serious spinal pathology.
RED FLAGS!
- violent trauma… Fall from height or automobile pathology.
- constant, progressive, non-mechanical pain.
- thoracic or abdo pain.
- night pain not eased by prone.
- ca, hiv, infx hx
- chronic corticosteroids
- constitutional sx
- significant and persistent lolittipbbof lumbar flexion.
- saddle anesth, urinary incont
Specialized tests of ct and mri should be reserved for cases in which surgery is being considered or strong suspicion of systemic dz.
What are the stages of back pain?
Acute- 0-4 wks… 80-100% likelihood of returning to n activity
Subacute - 4-12
Chronic/ persistent- > 12 wks…
What is a typical pattern of neuro sx in the absence of red flags and their resolution?
Often resolve without recourse to surgery.
When to refer to specialist consultation?
When there is an observed functional deficit that is persistent or deteriorating after 4 weeks.
