Back pain

Question 1

Case 1

Mechanical Pain ( umbrella term)

important thing is history

Answer 1

Gp most common pain
It can come from the spine, muscles, tendons, IV discs, or surrounding tissues.

Bad habits such as bad posture, strain/ Sprain, face joint arthritis, fracture, spondylolysis/Spondylolisthesis

It can be benign, self-limiting but can also be chronic

Rule out of red flags

Question 2

RED flags for back pain

Answer 2

Changes in sensation
Unexplained weight loss ( Cancer) AND FEVER WOULD BE (HIV, TB)
Bowel or bladder incontinence
Pain that is worse at night
Pain that wakes you up at night
Neuro symptoms such as paralysis of the lower limbs
Neck pain ( Upper limbs )
Changes in sexual function
use of steroid drugs
Bilateral sciatica
weakness or numbness in the limbs
thoracic pain
age-onset less than 20 or more than 55 years

Question 3

History questions

Answer 3

Are you sexually active
Can you get an erection
be open and give them a warning

If females, ask them is their vagina symptoms normal

Question 4

Sprain and strain

Answer 4

A sprain is when the ligaments are over-stretched or torn

Strain is when muscles or tendons affected

soft tissues become inflamed
( muscle spasm)

Can be debilitating (making it weak)

No imaging is required
NSAIDS and physiotherapy
90% recovery

Question 5

Facet Joints

Answer 5

Joints that connect corresponding vertebrae through the neural arch

synovial joints

Areas are prone to inflammatory and arthritic changes

Question 6

Degenerative changes

Answer 6

Bone outgrowth
Nerve impingement
Spinal stenosis ( Less common)

Question 7

Case 2

Spinal fracture

Answer 7

Osteoblast
Osteoporosis

Question 8

Different types of fractures

Answer 8

Compression
Burst
Flexion- distraction
Fracture - dislocation

Question 9

Likely cause of this is ?

Answer 9

Compression

Question 10

pain management

Answer 10

analgesia,
vertibral impengement

Question 11

Clinical Case 3
Sciatica

Answer 11

impingement
It will affect the nerves

Question 12

Clinical case 4

Lower back pain ( lifted piano)

Answer 12

Reduce anal tone and sensation
reduced sensation in the lateral foot

Question 13

Cauda quina syndrome (below L2 is the cauda quina)

it moves than the spinal cord ( Horsetail)

Urgent MRI spine, Analgesia

Referral to neurosurgeons for decompression

Answer 13

It is rare but medical emergency

it causes herniated, the ruptured disc is the most common

Spinal lesions, infections, and stenosis

Symptoms ( depend on degree of compression and precise nerve roots affected)

usually have back pain
Saddle anaesthesia, altered bowel, bladder function

Question 14

What is the likely cause?

Answer 14

Herniated disc

Question 15

Case 5

General back pain

Paraspinal and midline tenderness
Global weakness in lower limbs
Hyperreflexia, normal PR (tone and sensation)

Answer 15

Spinal metastasis

The third most common site for metastatic cancer

The most common primary sites are breast, lung, prostate, renal, and haematological cancers

It can occur in vertebrae, spinal cord, meninges, or spinal roots

Accurately concerned about MSCC

you can also get compression of

Question 16

Difference between CCS and SCC

Question 17

UNM lesion

Answer 17

Hyper
Spastic
Muscle groups
Hyper

Question 18

LMN lesion

Question 19

ASA chart

Answer 19

Spinothalamic tract - why using pinprick and light touch

Question 20

Case 6

Lower back pain

Reduced curvature of the lumbar spine with sacroiliac tenderness and reduced forward flexion. The Neuro exam is normal. but there is reduced chest expansion.

Answer 20

Pain radiates into the buttocks and has been worsening over the last 2 years.

Young age is a red flag