Back injury

Question 1

second most reason that people seek care in the ED, second to URI?

Answer 1

back pain

Question 2

back pain for how long is considered chronic?

Answer 2

over 12 weeks

Question 3

if you want to test S1 and S2, what moves should you have the patient perform?

Answer 3

toe walking (S1), plantar flexion (S1, S2)

Question 4

if you want to test L4 and L5, what moves should you have the patient perform?

Answer 4

dorsiflexion (L4, L5), heel walking (L5)

Question 5

squat and rise tests which spinal nerve?

Answer 5

L4

Question 6

achilles reflex tests which spinal nerve?

Answer 6

S1

Question 7

patellar reflex tests which spinal nerve?

Answer 7

L3-L4

Question 8

a positive SLR test is very sensitive for which back problem?

Answer 8

sciatica

Question 9

for what three types of indications in back pain would you order an MRI?

Answer 9

1) infection
2) neoplasm
3) compression syndromes (ie. cauda equina)

Question 10

when would a CT be appropriate when evaluating a patient’s back pain?

Answer 10

vertebral fractures (shows great detail of vertebral bodies)

poor imaging of spinal canal!

Question 11

what percentage of disc herniations are symptomatic?

Answer 11

only 3 percent; be careful of patient’s adopting a “sick” mindset leading to a lifetime of pain management and disability

Question 12

how do we treat non-specific MSK back pain?

Answer 12

NSAIDS, tylenol, muscle relaxants (flexeril)

activity!! no bed rest!

Question 13

what will a patient with sciatica most likely complain of?

Answer 13

radicular leg pain

Question 14

where do 95 percent of herniated discs occur?

Answer 14

L4-L5 or L5-S1

Question 15

if your patient with sciatica has no risk factors or neuro compromise, how should you treat them?

Answer 15

conservatively! same as non-specific MSK pain

80 percent improve without surgical intervention

Question 16

patient presents with pain that is aggravated with standing and extension, what jumps to the top of your DDX?

Answer 16

spinal stenosis

Question 17

in what positions will a patient with spinal stenosis have relief of their pain?

Answer 17

flexion and rest

Question 18

which type of back pain is correlated with pseudoclaudication (leg pain)?

Answer 18

spinal stenosis

Question 19

how do we treat someone with spinal stenosis?

Answer 19

refer to spinal surgeon; in these cases there IS a benefit to surgery

Question 20

if someone presents with neurological weakness in their leg, what is the best imaging test to order? what do you need to be sure to do first?

Answer 20

MRI!

give 10 mg dexamethasone IV first to reduce swelling

Question 21

how do we treat compression syndromes (cauda equina, conus medullaris)?

Answer 21

surgery!

drain hematoma, drain abscess, radiate cancer, surgical fixation

Question 22

when palpating an old lady’s spine, you notice vertebral step offs and pin-point tenderness at the level of L3…she doesn’t recall ever being injured. what’s the likely DX?

Answer 22

compression fracture

Question 23

best imaging for compression fracture?

Answer 23

MRI but X-ray is usually good enough

Question 24

in what population are spinal infections most prominent?

Answer 24

immunocompromised, diabetics, IVD, cancer, organ transplant, recent LP

Question 25

you always want to get an MRI when suspecting spinal infection, which type of infection is the one exception?

Answer 25

osteomyelitis

get plain films

Question 26

treatment of spinal infection?

Answer 26

admit! consult with surgeon, long term IV then PO ABX