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Simmons NURP 532 Exam 2 > 12: Lower Back Pain > Flashcards

12: Lower Back Pain Flashcards

1
Q

Lower back pain symptoms of _____ will usually go away.

A

Lower back pain symptoms of less than 3 months will usually go away.

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2
Q

T/F With lower back pain, it is not necessary to rush to imaging, esp after some type of movement, exercise, or heavy lifting.

A

True

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3
Q

Since back pain complaints may present in other parts of the body (d/t spinal nerve innervation), always have the spine in mind when dealing with _____.

A

Since back pain complaints may present in other parts of the body (d/t spinal nerve innervation), always have the spine in mind when dealing with extremities.

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4
Q

Compression fractures are common with _____.

A

Compression fractures are common with osteoporosis.

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5
Q

Nonmechanical spinal disorders are very uncommon (approximately 1% of low back pain). These include neoplasm, metastatic cancer, infections, inflammatory arthritis, and Paget’s disease. How might the pain differ with a nonmechanical cause?

A

Pain worsens at rest.

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6
Q

Which 6 conditions can cause referred back pain?

A
  1. PID
  2. Prostatitis
  3. Renal dx (pyelonephritis)
  4. Dissecting aortic aneurysm
  5. Gall bladder
  6. Ovarian cancer
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7
Q

What is the #1 cause of lumbosacral strain?

A

Improper lifting

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8
Q

After a lumbosacral strain, you should caution the patient that it may feel worse in the next _____.

A

After a lumbosacral strain, you should caution the patient that it may feel worse in the next 12-36 hours.

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9
Q

Which condition?

  • May have pain along waistband and into buttocks.
  • Aggravated by standing and flexion.
  • Pain is typically alleviated with rest and standing.
A

Lumbosacral strain

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10
Q

Disc protrudes out between vertebrae.

A

Herniated disc

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11
Q

_____ and _____ may coexist with a herniated disc.

A

DJD and arthritis may coexist with a herniated disc.

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12
Q

Outer portion of disc tears and extruded material can lie on nerve and cause chronic and radicular pain.

A

Herniated disc

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13
Q

Do herniated discs usually resolve?

A

New ones can resolve in 4-6 weeks with PT and rest in young to middle-aged adults. Can take up to 6 months for total recovery. Area remains weak.

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14
Q

Reflexes are absent or diminished when a nerve is _____.

A

Reflexes are absent or diminished when a nerve is completely compressed.

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15
Q

What is the most common herniated disc and why?

A

L5-S1 b/c all our body weight rests on our lower spine.

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16
Q

This acute back injury presents with loss of bladder and bowel control and weakness in the legs.

A

Cauda Equina

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17
Q

Which spinal nerves are affected in cauda equina?

A

T12-L1

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18
Q

T/F Cauda equina is a surgical emergency.

A

True

19
Q

Slippage of one vertebrae on top of another because of tears in ligaments that hold the spine straight.

A

Spondylolisthesis

20
Q

Spondylolisthesis is most common in what age group?

A

<26 yo

21
Q

Which condition?

  • Tight hamstrings
  • Hyperextension often reproduces pain
  • Family hx often positive
A

Spondylolisthesis

22
Q

Painful and progressive problem caused by compression or narrowing of the spinal cord or root canal.

A

Spinal Stenosis

23
Q

Spinal stenosis is most common in what age group?

A

Elderly

24
Q

Which condition?

  • Gradual onset of neurogenic claudication
  • Back and buttocks pain, and numbness or tingling with walking
  • Relieved with sitting
  • Leaning forward alleviates pressure
  • Walking aggravates pressure
A

Spinal Stenosis (Pain is unremitting because spinal canal is becoming narrower)

25
Q

Valsalva maneuver that causes radicular pain could indicate what?

A

Herniated disc

26
Q

Nighttime pain may suggest what?

A
  • Cancer
  • Infx
27
Q

Back pain combined with fever, weight loss, and malaise may suggest what?

A

Cancer that has metastasized to the spine

28
Q

On the neuro exam, how can you differentiate between vascular or spinal problems?

A

Check pulses and temperature of leg (indicates vascular)

29
Q

What are the 5 Waddell signs?

A
  1. Tenderness (excess or widespread)
  2. Simulation (pain reported with sham maneuvers)
  3. Distraction (less pain when attention is diverted)
  4. Regional (widespread give-away or dysthesia)
  5. Overreaction (disproportionate psychomotor responses)
30
Q

T/F Acute back pain resolves within 6-12 weeks, regardless of treatment.

A

True. Chronic (persistent) has a tremendous impact on life.

31
Q

Why is patience and understanding for patients with low back pain low?

A

You can’t see it

32
Q

What condition?

  • Radiculopathy with shooting pain down the leg.
  • May be from injury or herniated disc.
A

Sciatica (radiculopathy along sciatic nerve)

33
Q

Which test would initially be used for unrelenting rest pain?

A

X-ray (check for tumors)

34
Q

Which tests are used with a suspicion of cancer or infection?

A
  1. CBC
  2. ESR
  3. UA
35
Q

When would an MRI or bone scan be ordered?

A

Pain that persists beyond 4-6 weeks.

36
Q

What tests are used with prolonged sciatica?

A
  • MRI
  • CAT scan
  • If after 6-8 weeks, an electromyography
37
Q

6 points of treatment for low back pain.

A
  1. NSAIDs
  2. Muscle relaxers
  3. Pain Meds
    1. Avoid opioids (can be addictive and doesn’t help with inflammation and muscle problem)
    2. Pain 4-6: Tylenol or Vicodin
    3. Pain 7-10: Duragesic patch
  4. Physical therapy (mainstay)
  5. Minimize back stress (avoid lifting, pushing, pulling)
  6. Patient education (what to expect, next steps, diagnostic options, how to prevent in future, f/u and expectation)
38
Q

During the straight leg raise, the patient complains of radiculopathy down the opposite leg (you raise the right and it causes shooting pain in the left). What does this indicate?

A

Herniated disc

39
Q

Where is the sciatic notch located?

A

Between SI joint and ischial spine in the mid-gluteal area.

40
Q

What does a positive sciatic notch indicate and how would you treat?

A
  • Potential sciatica, herniated disc.
  • PT and antiinflammatories.
  • If no better or gets worse in 4-6 weeks, consider additional imaging.
41
Q

What is the center of the vertebral disc called?

A

Nucleus Pulposus

42
Q

What is the outer edge of the vertebral disc called?

A

Annulus Pulposus

43
Q

When might you test for the Waddell signs?

A

If you suspect malingering (feigning or exaggerating illness)

Simmons NURP 532 Exam 2 (25 decks)

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