3: PIVD and mechanical backache Flashcards

1
Q

What is a major aspect of the social history in someone with mechanical back pain?

A

Occupational history

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2
Q

What are some neurological symptoms associated with back pain?

A

Numbness

Pins and needles

Weakness

Bowel / bladder changes? think cauda equina

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3
Q

What are some red flag features of back pain?

A

Non-mechanical pain

Systemic symptoms (fever, nausea, weight loss, night sweats…)

New neurological symptoms

Saddle anaesthesia / bowel / bladder symptoms (cauda equina syndrome)

History of cancer

History of steroid use

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4
Q

What is saddle anaesthesia?

A

Anaesthesia limited to buttocks, thighs and perineum

major symptom of cauda equina syndrome

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5
Q

What does Schober’s method measure?

A

Lumbar spine flexion

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6
Q

What is the reference point for Schober’s test?

A

Sacroiliac dimples

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7
Q

What spinal movements is a patient asked to perform during a spine assessment?

A

Flexion

Extension

Lateral flexion

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8
Q

What is assessed during a neurological examination re: the spine?

A

Myotomes

Dermatomes

Reflexes

Nerve irritation

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9
Q

Which reflexes are tested during a neuro exam?

A

Knee jerk (L3/4)

Ankle jerk (L5)

Plantar reflex

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10
Q

How is sciatica tested for?

A

Leg raise

Aims to irritate nerves causing leg pain

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11
Q

What is the femoral stretch test used to elicit?

A

Upper leg nerve pain

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12
Q

Which nerve is affected in sciatica?

A

Sciatic nerve

L4 - S3

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13
Q

Are X-rays used to diagnose causes of back pain?

A

No, they usually don’t help much

Cause anxiety because irrelevant abnormalities will appear on the report

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14
Q

What is the gold standard investigation for back pain?

A

MRI scan

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15
Q

Which joints are commonly involved in back pain?

Which investigation can be done to check this?

A

Facet joints

Diagnostic facet injection with analgesia to see if symptoms improve

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16
Q

What type of joint are facet joints?

A

Synovial joints

17
Q

What is sciatica?

A

Buttock / leg pain in dermatome of sciatic nerve with neurological disturbance

18
Q

What spinal pathology causes a variety of different diseases?

A

Disc prolapse

19
Q

What is the normal presentation of disc prolapse?

A

Episodic back pain

then

Leg pain and neuro symptoms (sciatica) affecting specific myotomes and dermatomes

20
Q

Is disc prolapse an medical emergency?

A

No, unless it’s cauda equina syndrome

21
Q

Do all disc prolapses require surgery?

A

No, most settle themselves

22
Q

At what age do people tend to get disc prolapses?

A

30s - 50s

So if it’s not settling within 3 months it’s likely to severely disrupt their life

23
Q

If a patient’s disc prolapse isn’t resolving within 3 months, what is the next step?

A

Spinal surgery

24
Q

How is backache treated conservatively?

A

Bed rest for a short time

Simple analgesics, NSAIDs and muscle relaxants

Then mobilise the patient, physiotherapy, pain clinic, complementary therapy

25
Q

How many patients with back pain are suitable for surgery?

A

Very very few

26
Q

What is a progressive complication of facet fusion surgery?

A

Adjacent segment disease

Fusion spreads up to multiple levels - increasingly poor flexibility

27
Q

Factors like diagnosis, patient health and demographic actually matter little in terms of adverse factors for spinal surgery.

What are some significant adverse factors?

A

Yellow flags of back pain:

Patient is undergoing litigation

Disputes with government re: benefits

Chronic pain syndrome / behaviour