Back pain

Question 1

What are some red flag symptoms with back pain?

Answer 1

Non-mechanical pain
Systemic upset
New neurological deficit
Saddle anaesthesia +/- bladder/bowel upset.

Question 2

Name the myotome responsible for hip flexion

Answer 2

L1/2

Question 3

Name the myotome responsible for knee extension

Answer 3

L3/4

Question 4

Name the myotome responsible for EHL and foot dorsiflexion

Answer 4

L5

Question 5

How does sciatica present?

Answer 5

Buttock or leg pain in a specific dermatomal distribution with neurological disturbance

Question 6

How can disc prolapse present?

Answer 6

Episodic back pain
Onset of leg pain
Leg pain becomes dominant
Specific myotome and dermatome presentation

Question 7

When does disc prolapse become an emergency?

Answer 7

If involving cauda equina

Question 8

What is adjacent segment disease?

Answer 8

The vertebrae next to the affected disc is then affected too.

Question 9

Describe mechanical back pain

Answer 9

Recurrent and relapsing back pain with no neurological symptoms.
Worse on movement and relieved by rest.

Question 10

What are causes of mechanical back pain?

Answer 10

Obesity, poor posture, poor lifting technique, facet joint OA.

Question 11

What is the treatment for mechanical back pain?

Answer 11

Analgesia and physiotherapy.

Question 12

Why is bed rest not recommended as a treatment for mechanical back pain?

Answer 12

May lead to stiffness and spasm.

Question 13

What are the yellow flags involved in mechanical back pain?

Answer 13

Low mood
High levels of percieved pain
Job dissatisfaction
Belief that activity is harmful

Question 14

What pathology is worse on coughing?

Answer 14

Acute disc tear

Question 15

What is sciatica?

Answer 15

Herniation of nucleus pulposus on an exiting nerve root

Question 16

Where is the commonest site for sciatica ?

Answer 16

L4,5 and S1

Question 17

What is spinal stenosis?

Answer 17

Compression of multiple nerve roots, particularly in cauda equina

Question 18

What symptoms can present with spinal stenosis?

Answer 18

Burning pain
Pain is less walking uphill
Reserved pedal pulses
Claudication distance is inconsistent

Question 19

What is cauda equina syndrome?

Answer 19

Compression of all nerve roots at cauda equina caused by a very large central disc prolapse

Question 20

Why is cauda equina a surgical emergency?

Answer 20

Sacral nerve roots compressed so can cause saddle anaesthesia.
Long term it can cause permanent nerve damage

Question 21

A presentation of what symptoms must be considered as cauda equina?

Answer 21

Bilateral leg symptoms and any suggestion of altered bowel or bladder function

Question 22

What tests are needed if cauda equina is suspected?

Answer 22

PR

MRI

Question 23

What are some red flag symptoms in spinal conditions?

Answer 23

Back pain 60 yrs
Constant/severe/night pain
Systemic upset

Question 24

What is a crush fracture?

Answer 24

Spontaneous crush of the vertebral body due to severe osteoporosis

Question 25

What is spondylosis?

Answer 25

Degeneration of the intervertebral discs

Question 26

What is spondylothesis?

Answer 26

A shift in a vertebrae

Question 27

How might cervical spondylosis present?

Answer 27

Slow onset stiffness and pain in the neck which might radiate to the shoulders and occiput

Question 28

How might a cervical disc prolapse present?

Answer 28

Shooting neuralgic pain down a dermatomal distribution with weakness and loss of reflexes.

Question 29

Which nerve roots are normally affected in cervical disc prolapse?

Answer 29

C7 or C8 root

Question 30

What investigations can be carried out if a cervical disc prolapse is suspected?

Answer 30

MRI. | Findings should be co-ordinated with the clinical history.

Question 31

When can cervical spine instability occur?

Answer 31

Down syndrome | RA

Question 32

Why does cervical spine instability occur in RA?

Answer 32

Atlanto-axial subluxation due to destruction of the synovival joint between C1/C2

Question 33

What is the danger with a cervical instability?

Answer 33

Subluxation which could lead to cord compression