Flashcards in 3- Low Back Pain - An Osteopathic Approach Deck (35)
How long do you have to have back pain to be considered Chronic Low Back Pain?
> 3 months
A patient presents with lower back pain, what two prognosis must you eliminate immediately?
1) Cauda equina syndrome
2) Abdominal Aortic Aneurysm (AAA)
What is Cauda Equina Syndrome?
A large central disc herniation or other space occupying lesion compressing the cauda equina.
What are potential symptoms of cauda equina syndrome?
lower extremity weakness
bowel or bladder dysfunction
What is the treatment of cauda equina syndrome?
Decompressive surgery within 12 hours of onset of symptoms
What are the symptoms for a non-dissecting Abdominal Aortic Aneurysm (AAA)?
Hearing bruits or palpating a widened aorta
What are the symptoms for a dissecting Abdominal Aortic Aneurysm (AAA)?
Sudden onset of severe, tearing abdominal pain radiating to the back. May also hear bruit or palpate a widened aorta.
A patient presents with a dull continuous back pain and a low-grade fever of 99 degrees with a spasm over the paraspinals. What is the likely problem?
Diskitis or Osteomyelitis.
A patient with Diskitis or Osteomyelitis often has what type of HPI?
History of UTI, IV drugs, skin abscess or lumbar puncture
A 51 year old female patient presents with lower back pain that has gradually started and increased. At night, she says she still has pain and it is unrelieved by lying down or bed rest. She also lost a lot of weight recently. What could be her problem?
Tumor. IT IS A TUMOR! Blahhhhg!
Two 18 and 30 year old males present with morning back pain and SI joint pain/stiffness. When they work out, their pain decreases. What could be their problem? How do you test for this?
Ankylosing Spondylitis; Test for HLA B-27 (Hereditary autoimmune disease)
What are the general categorical causes for Low back pain?
Which is not a tumor related cause of LBP?
c) prostate metastatic caner
d) metastatic breast cancer
Which is not a rheumatologic related cause of LBP?
a) akylosing spondylitis
b) psoriatic arthritis
d) rheumatoid arthritis
c) osteomyelitis (infection, not rheumatologic related)
What is the most common metabolic cause of Low Back Pain? WHat do you ask/check?
Check bone density on postmenopausal women. Ask if they are shorter.
What are some psychogenic causes of Low Back Pain?
What are Vasulgenic causes of Low Back Pain
Epidural venous anomalies
What are Viscerogenic causes of Low Back Pain?
- Renal Colic (kidney stone?)
- Inflammatory bowel diseses (Crohn's or Ulcerative Colitis
How many different mechanical causes of low back pain exist?
a lot. seriously.. a lot.
What are common histories of patient with chronic low back pain?
Chronic Corticosteroid use
Recent lumbar puncture
Fevers, Chills, night sweats
A patient presents with low back pain that gradually started days later. The pain gets worse with activity and relieved with rest. What type of low back pain is the patient experiencing?
A patient presents with low back pain that gets worse with sitting, radicular pain and parestesias along the backside of his thigh. Pain increases when he is constipated and trying to take a dump (Valsalva maneuver). What type of low back pain is the patient experiencing?
A 40 y/o patient presents with low back pain that that gets worse at night. He also experiences fever, chills, night sweats, weight loss and constant pain. What type of low back pain is the patient experiencing?
A 13 year old gymnast comes in complaining of chronic lower back pain. The pain often gets worse when she extends her back on her left side. What type of low back pain is the patient experiencing?
What are the red flags of chronic low back pain?
- Recent trauma
- Unexplained weight loss or feer
- Cancer (or history of cancer)
- IV drug use
- Osteoporosis/glucoorticoid use
- Age 70+
- Focal neurologic deficit progressive or disabling -symptoms
- Duration 6+ weeks
If you suspect an L4 root problem, what do you test?
patellar reflex and quad strength
If you suspect an L5 root problem, what do you test?
Ankle and Big Toe dorsiflexion
If you suspect an S1 root problem, what do you test?
If you suspect malingering, what do you test?
Straight leg raise for positive radicular pain either seated or supine.