Back Pain Flashcards
(46 cards)
what components contribute to back pain
biological
psychological
social
what should be included in the Hx of back pain
onset previous episodes site and nature of pain radiation of pain neuro symptoms
red flags of back pain in history
- Non – mechanical pain; pain that does not vary with activity
- Systemic upset
- Major, new, neurological deficit
- Saddle anaesthesia (loss of feeling localised at the buttocks) +/- bladder or bowel upset
myotomes involved in - hip flexion, knee extension, foot dorsiflexion & EHL and ankle plantarflexion
Hip flexion - L1/2
Knee extension - L3/4
Foot dorsiflexion & EHL - L5
Ankle plantar flexion - S1/2
what is overt pain behaviour
Guarding Bracing Rubbing Grimacing Sighing
what is mechanical back pain
recurrent relapsing and remitting back pain with no neuro symptoms.
worse with movement; relieved by rest
what can cause mechanical back pain
obesity poor posture lack of physical activity degenerative disc prolapse facet joint OA spondylosis
what is spondylosis
disc degeneration leading to increased loading and accelerated OA of the facet joints
Tx for mechanical back pain
Analgesia
Physiotherapy
what can be done to test nerve irritation
straight leg test
what Ix is not advised in back pain
x-ray
- will see pathology related to age; red herring
main first line Ix for back pain
MRI
what is sciatica
Buttock and / or leg pain in a specific dermatomal distribution accompanied by neurological disturbance.
what is normal presentation of disc prolapse
variety of syndromes and presentations
leg pain and neurology important feature
when is surgery preformed in disc prolapse cases
for leg pain
what is common presentation of disc prolapse
Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dominant
Myotomes and dermatomes will tell you where the disc prolapse is
what is the Tx for disc prolapse
70% settle in 3 months
90% settle in 18-24 months
consider surgery after 3 months - open discectomy
Mx of Backache
short bed rest
anti-inflmmatory +/- muscle relaxant
mobilise
normal activity
what does backache often accompany
headache and tiredness
increased diagnosis of mental disorder
why is surgery in back pain controversial
long term results (>5 years) are the same whether operated on or not
what is the typical Hx of spinal claudication
Age 50 +
M > F
Heavy duty job
Obese
symptoms spinal claudication presents with
Limited walking capacity
stoop/sit/lean forward to relieve symptoms
‘heavy’ or ‘tired’ legs
how can spinal claudication be differentiated from vascular claudication
spinal
- Relieved by flexing
- Uphill often not bad
- Cycling easy
vascular
- relieved by standing
- uphill bad
- cycling bad
what causes spinal claudication
spinal stenosis
