Back and Neck Pain Flashcards Preview

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Flashcards in Back and Neck Pain Deck (22)
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Local pain

Pain localizes to a specific place in the back

Causes: Fractures, tears, stretching of pain-sensitive structures


Referred pain

Pain originates from a visceral organ and is referred to the back

Causes: AAA, pancreatitis, renal calculi, perforated peptic ulcer


Radicular back pain

Sharp, radiating into the dermatomal distribution of a dermatomal distribution of a nerve root. Made worse with any Valsalva maneuver

Causes: Herniated lumbar disc, degenerative joint disease at the intervertebral foramen, epidural disease


Muscle spasms

Painful spasms in the paravertebral muscles. Usually paroxysmal

Causes: Usually of unclear origin


Red flags for possible serious underlying process.

These patients should be imaged

1) Age over 50
2) History of cancer
3) Pain for more than a month
4) No relief even with bedrest
5) Bowel or bladder incontinence
6) Focal leg weakness or numbness
7) Glucocorticoid or IV drug use
8) Current systemic infection
9) Unexplained fever or weight loss
10) Reproducible percussion tenderness over the spine
11) CVA tenderness


L2 lumbosacral radiculopathy

Reflex - none

Sensation - upper anterior thigh

Weakness - iliopsoas

Pain - Anterior thigh


L3 radiculopathy

Reflex - None

Sensation - Anterior knee

Weakness - Iliopsoas, Quads, Hip adductors

Pain - Anterior knee


L4 radiculopathy

Reflex - Patellar

Sensation - Medial calf

Weakness - Quads, Tibialis anterior

Pain - Medial calf


L5 radiculopathy

Reflex - none

Sensation - Dorsomedial surface of foot, lateral calf

Weakness - Peronei, tibialis anterior, extensor hallicus

Pain - Lateral calf, dorsomedial foot, buttocks/posterior thigh


S1 radiculopathy

Reflex - Achilles

Sensation - Plantar and lateral surfaces of the foot

Weakness - Gastrocnemius, Soleus, Gluteus maximus

Pain - Plantar and lateral foot, buttocks/posterior thigh


C5 radiculopathy

Reflex - Biceps

Sensations - Shoulder, thumb

Weakness - Deltoid, biceps

Pain - Medial scapula, lateral arm


C6 radiculopathy

Reflex - Biceps

Sensations - thumb, index finger, radial hand, lateral forearm

Weakness - Biceps, pronator teres

Pain - Lateral forearm, first 2 digits


C7 radiculopathy

Reflex - Triceps

Sensation - Middle digits, posterior forearm

Weakness - triceps, wrist extensors, finger extensors

Pain - Posterior arm and forearm, middle digits


C8 radiculopathy

Reflex - Finger flexors

Sensation - fifth digit, medial hand, medial forearm

Weakness - Intrinsic hand muscles

Pain - Last 2 digits, medial forearm


T1 radiculopathy

Reflex - Finger flexors

Sensation - medial arm, axilla

Weakness - intrinsic hand muscles

Pain - medial arm, axilla


Lumbosacral sprain

Confined to lower back with no radiation or neuro deficits. Paraspinal muscle spasms cause patients to assume unusual postures. Usually post-traumatic

Workup: None needed

Tx: Encourage light exercise and return to normal activity. Consider PT referral. Prescribe NSAIDs or acetaminophen. Use opioids and muscle relaxants carefully


Vertebral fracture

Caused by trauma, osteoporosis or vertebral tumor. Persistent local pain with overlying paraspinal muscle spasm. Neuro deficit from radiculopathy may be present

Workup: Plain radiographs initially. Bone scan or MRI if pathologic fracture from tumor suspected

Tx: Ensure adequate pain control. Ortho consult. May be candidate for kyphoplasty


Lumbar disc disease

Presents with limitation of spine flexion and radiculopathic features. Most common at L4-L5 and L5-S1. Exacerbated by Valsalva

Workup: If no red flags, may manage conservatively for one month. MRI is the best diagnostic test. Note that many patients with no back pain have herniated disks on MRI

Tx: See lumbosacral strain. Surgery indicated for progressive motor weakness, abnormal bowel or bladder function and incapacitating radicular pain with MRI correlation


Spinal stenosis

Caused by a narrowed spinal cord. Back and bilateral leg pain provoked by standing or walking, known as pseudoclaudication. Usually relieved by sitting.

Workup: MRI is most sensitive

Tx: Conservative treatment with NSAIDs, other pain relievers and PT. Surgical management when pain is incapacitating or severe focal deficits develop



Pain usually caused by osteophytes which may compress nerve roots. Pain centered in the spine increased by motion. associated with limitation of motion

Workup: Plain films will show osteophytes and can suggest whether there is narrowing of the intervertebral foramen. MRI and CT more sensitive

Tx: Conservative treatment with NSAIDs, other pain relievers and PT. Surg when pain is incapacitating or severe focal deficits develop



Back pain is a common neuro complaint in cancer patients and may herald a diagnosis. The pain is usually constant, dull, unrelieved by rest and worse at night.

Workup: MRI is the most sensitive study for evaluating epidural disease and vertebral mets. Bone scan and CT also play a role.

Tx: Intractable pain from vertebral mets may respond to radiation depending on tumor type. Neuro deficits from epidural disease demand radiation or surgery



Epidural abscess presents with fever and back pain aggravated by palpation or movement. Vertebral osteomyelitis may not present with fever.

Workup: MRI

Tx: ABx and surgical management are usually combined