Acute and chronic Lower Back Pain Flashcards Preview

MSK/Rheumatology (Inpt) > Acute and chronic Lower Back Pain > Flashcards

Flashcards in Acute and chronic Lower Back Pain Deck (66):
1

most common cause of low back pain?

prolapsed intervertebral disk and low back strain

2

what does pain orginiating iin the back and radiating down the leg mean?

nerve root damage

3

what does localized pain mean?

more likely MSK cause

4

sciatica

pain in the distribution of the sciatic nerve- felt in the buttock, posterior thigh, postero-lateral aspect of the leg, lateral malleolus to the lateral dorsum of the foot

5

unilateral low back and buttock pain?

esp if gets worse w/ standing--> sacroiliac joint involvment

6

pain in elderly that is increased by walking and relieved by leaning forward?

spinal stenosis

7

low back pain red flags?

fever, weight loss, morning stiffness, hx of IV drug or steroid use, trauma, hx of cancer, saddle anesthesia, loss of anal sphincter tone, major motor weakness

8

What is a CT helpful for

bony stenosis and identifying lateral nerve root entrapment

9

what is a MRI helpful for?

identifying cord pathology , neural tumors, stinosis, herniated disks,infx

10

costochondritis

insidious onset of anterior chest wall pain exacerbated by certain movmentes of the chest and deep inflammation

11

PE of costochondritis

pain is reproducible upone exam-palpation of costochondral joings

12

tx of costochondirits?

NSIADS (add PPi if risk of GI bleed)

13

what is costochondritis is infections?

surgical drainage and or debridement w/ appropriate abx

14

de Quervians sydrome?

stenosing tenosynovities involving abductor pollicis longus, extensore pollicis brevis (APL, EPB)

15

dx for DQ Syndrome?

Finklestein's test

16

tx of DQ syndrome?

thumb spica splint, NSAIDs, PT for at least a mnth

*can injx steroid into tendon sheath

may need surgical decompression of the first dorsal compartment

17

Bursitis

inflammatory ds of the bursa

can be caused by trauma or over use

18

common sites of bursitis?

subacromial, subdeltoid, trochanteric, ischial, ilipsoas, olecranon, prepatellar and suprapateller

19

what is housemaid's knee?

suprapatellar bursitis

20

CF of bursitis>

pain, swelling, tenderness that can persist for wks

21

tx of bursitis?

prevention, NSAIDs, steroid injgx

22

tendonitis

inflammation of the tendone

23

tenosynotvitis

inflammation of the enclosed tendon sheat

24

what are common cause of tenosynotivits?

over use, or systemic dz

25

what sites do you commonly see tendinitis and tenosynovitis?

rotator cuff, supraspinatus, biceps, flexor carpi ulnaris, flexor carpi radialis, flexor digitorum, patella, hip adductor, and Achilles

26

CF of tendonitis?

pain with movement, swelling, and impaired function.
o The condition may resolve over several weeks, but recurrence is common

27

tx of tenosenovitis?

o Ice, rest, and stretching help to relieve inflammation
o NSAIDs may alleviate pain but do not penetrate the tendon circulation adequately. An injection with corticosteroids combined with anesthesia and administered alongside the tendon may be beneficial. Intratendon injection should be avoided because of the risk of rupture
o Excision of scar tissue and necrotic debris may be performed if conservative measures are unsuccessful. The scar tissue is caused by repetitive microtrauma to the tissue.

28

REactive arthritis

- A seronegative arthritis that presents with a tetrad of urethritis, conjunctivitis, oligoarthritis, and mucosal ulcers

29

what is reactive arthritis a common sequalae of?

STIs (chlamydial urethritis or Ureaplasma) or gastroenteritis (Shigella, Salmonella, Yersinia or Campylobacter)

30

what joints are usually involved in reactive arthritis?

larger joints, usually below the waist (knee/ankle)

31

what dx fx may be see in reactive arthritis?

HLA-B27 +

32

tx of reactive

PT and NSAids

33

Septic arthritis

- The hematogenous spread of bacteremia, periarticular osteomyelitis, infection caused by diagnostic or therapeutic procedure (e.g., intra-articular injection), or infection elsewhere (e.g., cellulitis, bursitis) may lead to infectious arthritis

34

CF of Septic arthritis?

involves single joint (most commonly the knee, followed by hip, shoulder, ankle wrist

-swelling, fever, joint warmth and effusion, TTP, increased pain w. minimal ROM

35

what is the most common cause of septic arthritis?

staph aureus

36

what can also cause Septic arthritis (think sexually active young adults

N. gonorrhea

37

joint tap of Septic arthrists

yellow-green,

WBC > 50,000

PMN 75%

culture is positive

38

tx for septic arthritis

IV abx for 2 wks, ceftriaxone is remcommended for empriic tx

adjustment of abx post culture and sensitivity

-arthrotomy and arthrocentisis is oftne needed, (not if N gonorrhea is the causative agent though)

-oral abx should follow IV ab x for up to 2 wks after

39

Psoriatic arthritis

inflammatory arthritis w/ skin involvement usually preceding joint dz by mnths to years

40

CF of Psoriatic arthritis

-mild/intermittent course affecting a few joings

-may resemble RA may involvve hands and feet

-pitting of nails and onycholysys may be seen

-sausage-finger appearance cuased by arthritis and tenosynovits of flexor tendon

41

DX studies of psoriatic arthritis

elevated ESR,

normocytic, normochromic anemia

hyperuriciemia canbeen seen

normal RF

42

"pencil in a cup"?

seen with psoriatic arthritis, deformity of the proximal pahlanx on radiography

43

tx of psoriatic arthritis
?

- Treat mild cases with NSAIDS
- Methotrexate for skin inflammation and arthritis
- Avoid corticosteroids and antimalarials
- May need reconstructive surgery (arthrodesis or joint replacement) for painful end-stage arthropathy

44

ganglion cysts

- Benign lesion sac of synovial fluid, most often on dorsal aspect of hand and/or wrist. Seen more in females. Aspiration can be therapeutic and diagnostic

45

tx of ganglion cysts

surgical excision. Patients with neurovascular compromise will go straight to surgical route

46

Polymyalgia Rheumatica

pain and stiffness in the neck, shoulder pelvic girdles and is accompained by constitutional sx (like fever, fatigue, weight loss, depression)

47

epidimiology or polymyagia rheumatica

affects women twice as often as men usually presents in pts older than 50 yrs

48

etiology of polymyalgia rheumatica

cause is unknown, may be associated w/ giant cell temporal arteritis

49

Clinical features of polymyalgian rheumatica

-stiffness, most severe after rest and in the am

-MSK sx usually are bilateral, proximal, symmetrical

giant cell must be ruled out (sclap tenderness, jaw claudication HA temporal artery tenderness)

50

dx studes of polymyalgia rheymatica?

EsR elevaated (

(temporal arteritis confirmed by bx need at least 2.5 cm)

51

tx of polymyalagia rheumatica

low-dose corticosteroid therapy, which may be required for up to 2 years and slowly tapered

52

SLE

- An autoimmune disorder characterized by inflammation and positive ANAs and involvement of multiple organs

53

who is commonly affected by SLE

AA women of childbearing age

54

dx of SLE?

4 of the following must be met (and high titer ANA)
o Malar rash
o Discoid rash
o Photosensitivity
o Oral ulcers
o Arthritis
o Serositis (heart, lungs, or peritoneal)
o Renal disease (proteinuria, cellular casts)
o ANA
o Hematologic disorders (hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia)
o Immunologic disorders (LE cell, anti-DNA, anti-Sm, false-positive serologic test for syphilis)
o Neurologic disorders (seizures or psychosis in absence of any other cause

55

what must be ruled out when trying to dx SLE

- Drug-induced lupus must be rule out. There are many drugs that cause a lupus-like syndrome
o Procainamide, hydralazine, isoniazid, methyldopa, quinidine, chlorpromazine

56

Routine lab studies for an SLE workup

CBC, BUN, creatinine, urinalysis, ESR, serum complement (C3 or C4)
o Antibodies to Smith antigen, double-stranded DNA, or depressed levels of serum complement may be used as markers for disease progression
o ANA is present (99%), but low titers have low predictive value

57

tx of SLE

o Regular exercise and sun protection are important for all patients
o NSAIDs for musculoskeletal complains
o Antimalarials (quinacrine, hydroxychloroquine) can be used for musculoskeletal complaints or cutaneous manifestations
o Corticosteroids (topical or intralesional) for cutaneous manifestations
 Low or high dose oral corticosteroids used for disease flares and tapered as symptoms resolve
o Methotrexate is used at low doses for arthritis, rashes, serositis, constitutional symptoms

58

fibromyalgia

central pain disorder whose cause and pathogenesis are poorly understood

59

what can FM occur with?

RA, SLE, Sjorgren's syndrome

60

CF of FM?

nonarticular MSK aches, pains, fatigue, sleep disturbance, multiple tender points on exam

-anxiety depression, HA, IBS, dysmenorrhea, paresthesias

61

what do you need to rule out when working up FM?

hypothyroidism, chep C, vitamin D def

62

how to tx FM?

pregabalin (lyrica) is the only FDA approved drug for it

63

adr of pergabalin?

fatigue, trouble concentrationg, sleepiness, edema

64

morton's neuroma

- A result of traction of the interdigital nerve against the transverse metatarsal ligament causing degeneration of the nerve and chronic inflammation

65

CF of Morton's neuroma

of pain and localized numbness when walking and standing, which is relieved with rest
- Pain is usually localized to the web space and, often, a mass is palpable
- Squeezing the forefoot will often reproduce the symptoms

66

tx of morton's neuroma

- Conservative treatment using a soft metatarsal pad and shoes with a wide toe box are helpful
- Steroid injections into the web space can be helpful
- Surgical removal of the neuroma is possible in cases that are not resolved with conservative treatment, but the patient should be aware that both toes will be chronically numb