Back Pain Flashcards by user delete

what are the red flags of back pain?

-pain in patient 60
-constant pain, pain that is worse at night
(ie non-mechanical pain)
-systemic upset
-major, new neurological deficit
-saddle anaesthesia +/-bladder/bowel upset
-PHx of cancer

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what myotomes are in control of hip flexion?

L1/2

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what myotomes are in control of knee extension?

L3/4

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what myotomes are in control of foot dorsiflexion?

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what myotomes are in control of ankle plantarflexion?

S1/2

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how do you test L1/2? (hip flexion)

push on anterior aspect of thigh and ask patient to push up against your hand

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how do you test L3/4? (knee extension)

when knee is flexed, push on anterior aspect of leg and ask patient to straighten their knee against your hand

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how do you test for superficial/ non-anatomical tenderness?

pinch the skin

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what is axial loading testing?

applying pressure on the spine by pushing on head- this should not increase pain, but if patient says it does you need to consider psychosocial factors

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what is sciatica?

buttock or leg pain caused by irritation of the sciatic nerve

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what is the timing of back pain due to a disc prolapse?

episodic

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what pain tends to become dominant over the back pain in a disc prolapse?

leg pain

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when is a prolapsed disc an emergency?

if there are cauda equina symptoms/signs

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when do you consider surgery for a disc prolapse?

if pain is not resolving after 3 months

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why do you not immediately consider surgery for a disc prolapse?

long term results of conservative treatments are the same

most resolve on their own

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what is adjacent segment disease?

symptomatic disease of the spinal segments adjacent to a fusion operation

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what is cauda equina syndroma?

pressure or swelling on the nerves of the cauda equina, untreated can lead to paralysis

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what are the 2 main initial symptoms of cauda equina syndrome?

various urinary upsets

- painless urinary retention with overflow

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when taking an C-ray of the cervical spine what must you ensure the X-ray shows?

C7/T1

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what does saddle sparing do to the diagnosis of complete cord injury?

no longer complete cord injury

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what type of movements typically are more likely to have central cord injury?

hyperextension

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what is Brown-Sequard syndrome?

damage to one side of the spinal cord causing paralysis on the ipsilateral side and hypaesthesia on the contralateral side

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what is brown-sequard syndrome usually seen in?

trauma

ie fracture

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what is anterior cord syndrome?

damage to the 2/3 anterior of the spinal cord causing motor loss, loss of pain and temperature but preservation of fine touch and proprioception

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what is anterior cord syndrome usually seen in?

vascular supply problem

why in anterior cord syndrome are fine touch and proprioception preserved but pain and temperature are lost?

fine touch and proprioception are carried in posterior tracts pain and temperature are carried in anterior/lateral tracts (which are damaged)

what is the benefit of a short segment fusion over a long segment fixation surgery?

in short fusion the implant doesn't need to be removed | in long fixation the implant has to be removed after 1 year

what are the differences between spinal and vascular claudication in terms of what happens on standing?

vascular claudication is relieved by standing spinal claudication is made worse

what are the differences between spinal and vascular claudication in terms of what happens on flexing?

spinal claudication is relieved by flexing vacular claudication is not

what are the differences between spinal and vascular claudication in terms of what happens on walking up hill?

vascular claudication pain is worse on walking up hills in spinal claudication pain might actually improve (due to flexed position)

what are the differences between spinal and vascular claudication in terms of cycling?

in spinal claudication cycling is easy (due to flexed position) in vascular claudication all sport/exercise (like cycling) is difficult

what kind of pain occurs with a patient with a degenerative disc?

aching, poorly-localised, central back pain- usually lower back (discogenic pain)

what happens to discogenic pain as the day goes on?

becomes worse

what happens to discogenic pain on activity?

becomes worse

how long does it take a patient with facet arthropathy to 'loosen up# in the mornings?

about 20 minutes

compare discogenic pain to facet arthropathy in terms of what movement make the pain worse?

facet arthropathy is worse with extension | discogenic pain is worse with flexion

what is the surgical treatment of a prolapsed disc?

disectomy

what is the surgical treatment of a disc degeneration?

interbody fusion

what is the surgical treatment of spinal stenosis causing claudication?

root decompression and then stabilisation

what is the surgical treatment of facet arthritis?

excision of facets and fusion

what is mechanical back pain?

recurrent relapsing and remitting back pain with no neurological symptoms (no red flag symptoms present)

what exacerbated mechanical back pain?

movement

what relieves mechanical back pain?

rest

what age are patients typically when tehy present with mechanical back pain?

20-60 years ol

what are the 8 main causes of mechanical back pain?

- obesity - poor posture - poor lifting technique - lack of physical activity - depression - degenerative disc prolapse - facet joint OA - spondylosis

what is spondylosis?

where the invertebral discs lose water content with age resulting in less cushioning and increased pressure on facet joints

what can spondylosis commonly lead to?

facet joint OA (due to increased pressure)

what is the mainstay of treatment for mechanical back pain?

analgesia and physiotherapy

why should bed rest be avoided in patients with mechanical back pain?

will lead to stiffness and spasm of the back which may exacerbate disability

what minority of patients with mechanical back pain can be considered for spinal stabilisation?

-single level (ie 2 adjacent vertebrae) affected by OA or instability AND -patient has not improved despite physio and conservative management

what is vertebral instability?

excessive motion caused by degenerative disc

how is vertebral instability typically diagnosed?

MRI

what part of the invertebral disc is involved in an acute disc tear?

annulus fibrosis

what is the classic activity that causes an acute disc tear?

lifting a heavy object

what characteristically exacerbates the pain from an acute disc tear?

coughing

what is the mainstay of treatment for an acute disc tear?

analgesia and physiotherapy

what can happen to the nucleus polposis of an intervertebral disc after an acute disc tear?

it can herniate or prolapse through the tear

what is the treatment of OA if the facet joints causing nerve root impingement?

surgical decompression with trimming of impinging osteophytes

what is spinal stenosis?

when there is not enough space for the cauda equina so nerve roots become compressed/irritates

compare spinal claudication to vascular claudication in terms of distance at which pain starts?

vascular- distance is consistent | spinal- distance is inconsistent

compare spinal claudication to vacular claudication in terms of the type of pain?

vascular- cramping | spinal- burning

why is the pain in spinal claudication less when walking uphill?

spine flexion creates more space for the cauda equina

what is the first line treatment of spinal stenosis?

conservative treatment | with physio and weight loss

when can decompression surgery be considered for a patient with spinal stenosis?

-if symptoms fail to improve with conservative treatment AND -if evidence of stenosis on MRI

what is cauda equina syndrome?

a surgical emergency where a large disc prolapse compresses all the nerve roots of the cauda equina

if a patient comes in with bilateral leg symptoms/signs and any suggestion of altered bladder/bowel function, what is this condition until proven otherwise?

cauda equina syndrome

if you suspect cauda equina syndrome what are the 3 main necessary steps?

- rectal examination - MRI - urgent discetomy

what are the main symptoms/signs a spontaneous osteoporotic rush fracture can lead to?

- acute pain - chronic pain (due to altered spinal mechanics) - kyphosis

what is the managment of osteoporotic crush fractures?

conservative

what is the new operative management of osteoporotic crush fractures?

balloon vertebroplasty

what is the management for less severe cases of atlanto-axial subluxation?

treated with a collar to prevent flexion

what is the management for more severe cases of atlanto-axial subluxation?

surgical fusion

what are the 2 main conditions which are known for atraumatic cervical spine instability?

rheumatoid arthritis | down's syndrome

What are the 4 types of low back pain that make up the diagnostic triage?

simple back pain nerve root pain serious spinal cauda equina syndrome

describe the leg pain in a patient with nerve root pain?

unilateral leg pain which is greater than the back pain also parasthesia in the same distribution

compare the ages of simple back pain and serious spinal pathology?

simple back pain: 20-55 | serious spinal pathology 55

compare the timing of pain between simple back pain and serious spinal pathology?

simple- occurs during movement | serious spinal pathology- constant unremitting

Back Pain Flashcards

(77 cards)