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Musculoskeletal > Spine: PIVD and backache > Flashcards

Spine: PIVD and backache Flashcards

1
Q

What is important to understand about history of backache

A

Usually insidious onset
Exact date suggests different cause
Beware

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2
Q

What are the Red Flags of back pain?

A

Non mechanical
Systemic upset
Major, new, neuro deficit
Saddle anaesthesia +/- bladder/bowel upset

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3
Q

What is non mechanical pain?

A

Doesn’t vary with activity of time of day

Pain worse at night

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4
Q

What is involved in examination of the back?

A 
observation
range of movements
neuro assessment
nerve root irritation
distraction testing
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5
Q

How do you observe the back?

A

Posteriorly
Laterally
With forward flexion to accentuate deformity

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6
Q

How do you assess range of movement?

A

Schober’s test forward flexion
Qualtative extention
Lateral flexion

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7
Q

what is involved with a neurological assessment of the back?

A

myotomes
dermatomes
reflexes
nerve irritation

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8
Q

What myotomes are involved in

a) hip flexion
b) knee extention
c) foot dorsiflexion and Extensor Hallicus Longus
d) ankle plantarflexion?

A

a) L1/L2 (push up against your hand)
b) L3/L4 (straighten knee against your hand)
c) L5 (extend against your hand)
d) S1/S2 (stand on tip toes)

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9
Q

What are additional signs to look for when assessing pain?

A 
pain drawing
behavioural symptoms
behavioural signs
overt pain behaviour
walking aids
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10
Q

What are examples of overt pain behaviour?

A 
guarding
bracing
rubbing
grimacing
sighing
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11
Q

How can you assess a patient who can’t flex their hip to the desired 90 degrees?

A

Get them to sit up

will now unknowingly be at 90 degrees

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12
Q

Why should you beware of x rays in back pain?

A

will show up age related degeneration

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13
Q

What investigations can be used for back pain?

A 
Xray (beware)
MRI (beware)
Facet injection
Contrast CT
Provocation discography
Nerve block/ablation
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14
Q

What is sciatica?

A

buttock and or leg pain
specific dermatomal distribution
accompanied neuro disturbances

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15
Q

How does disc prolapse relate to sciatica?

A

Causes leg pain and neurology
Surgery of disc to treat leg pain
effect on back pain uncertain

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16
Q

How do prolapsed discs present?

A

Episodic back pain
onset leg pain +/-neurology
Leg pain becomes dominating complaint
myotomes and dermatomal dirstribution

17
Q

How is disc prolapse treated?

A 
Not emergency
Beware of cauda equina (is an emergency)
most will settle in 3 months
even more settle in 24 months
Surgery -only consider if not resolved in 3 months (risky, only speeds up natural process)
18
Q

How can you manage backache?

A 
1st: Short bed rest (debatable)
anti inflammatory +/- muscle relaxant
exercise
2nd: physiotherapy
chiropractic
pain clinic
complementary therapy
Surgery
19
Q

What treatments are discredited in back ache?

A 
bed rest
bed rest and traction
narcotics >2weeks
benzodiazapine >2 weeks
steroids
plaster jacket
manipulation under GA
20
Q

What is the major risk of back surgery?

A

Adjacent segment disease
after fusion of facets
multi level disease

21
Q

What are the adverse factors of spinal surgery?

A

Litigation
Dispute with DSS
Chronic pain syndrome

22
Q

What contributes to chronic pain syndrome?

A 
central pain perception
dorsal horn (NMDA receptors)
Mid brain
anterior cingulate region
cord changes
pain and psychosocial
23
Q

What are the dysfunctional syndromes?

A 
Back pain
Chronic fatigue
Fibromyalgia
IBS
Migrane
Chronic pelvic pain
24
Q

What are behavioural symptoms of pain?

A 
Pain at tip of coccyx
whole leg pain
whole leg numbness
whole leg giving way
absence of pain free spells
intolerant of treatment
emergency admission
25
Q

What blood tests can be done in a back pain presentation?

A

esr
pv
Ca2+
ALK Phos

26
Q

What are the yellow flags for back pain?

A 
low mood
high levels pain/disability
belief that activity is harmful
low education
obesity
secondary gain (claims)
job dissatisfaction
light duties not available at work
lot of lifting at work
27
Q

What are the signs of facet arthropathy?

A 
Morning stiffness
lossen up routine
restless
difficulty sitting, driving, standing
worse with extension
better with activity
often radiates to buttucks and legs

Musculoskeletal (7 decks)

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