Back Pain

Question 1

What are the differen types of back pain?

Answer 1

Viscerogenic (abdomen)
Spondylogenic (joints and muscles)
Discogenic (IV disc)
Neurogenic (nerve root)
Psychoenic

Question 2

What can cause viscerogenic pain?

Answer 2

Peptic ulcer disease
Gallbladder 
Pancreas
Renal
Uterine/ ovarian
Colonic
AAA

Question 3

What needs to be assessed in back pain?

Answer 3

SOCRATES

Question 4

What type of pain is nerve root leg pain?

Answer 4

SCIATICA
Dermatomal
Sharp, shooting pain 
Goes below the knee to the foot and ankle 
Anatomical sensory/motor symptoms

Question 5

What type of leg pain does referred leg pain from facet joints cause?

Answer 5

Non specific 
Dull pain
Common in buttocks and thigh
Never below knee 
Ill-defined sensory symptoms

Question 6

What neurological symptoms will back pain cause?

Answer 6

Bowel and urinary incontinence
Bilateral or unilateral leg symptoms
Paraesthesia
Numbness
Weakness

Question 7

What features are red flags in back pain?

Answer 7

Non-mechanical pain
Thoracic pain
PH - carcionoma, steroids, HIV
Systemic upset
Major, new neurological deficit
Saddle anaesthesia +/- bladder or bowel upset

Question 8

What spinal pathologies can cause back pain?

Answer 8

OA can cause wedge fractures
Tumours - primary myeloma or mets
Infection - destruction of vertebrae and pus
Ankylosing spondylitis

Question 9

What cancers commonly metastasise to the spine?

Answer 9

Bad Boys Pee Through Kidneys

Breast, Bronchus, Prostate, Thyroid, Kidney

Question 10

What are the different types of disc prolapse?

Answer 10

Prolapsed (still contained within the posterior ligament)
Extruded
Sequestrated

Question 11

How can large vertebral canal cause back pain?

Answer 11

Stretched annulus/ posteiror long ligament

Question 12

How can small vertebral canals cause back pain?

Answer 12

Root compression causes release of inflammatory mediators

Root pain and tension signs

Question 13

Where will sacroiliac joint pain refer to?

Answer 13

Buttock, back of thighs and facet joints in spine

Question 14

What is spondylolisthesis?

Answer 14

Spondylolisthesis is a slipping of vertebra that occurs, in most cases, at the base of the spine

Question 15

What is spondylolysis?

Answer 15

Defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5)

Question 16

What should be examined in a back pain exam?

Answer 16

Observation
Range of movement
Neruological assessment
Nerve root irritation
Distraction testing

Question 17

What nerves allow for hip flexion?

Answer 17

L1/2

Question 18

What nerves allow for knee extenion?

Answer 18

L3/4

Question 19

What nerves allow for foot dorsiflexion?

Answer 19

L5

Question 20

What nerves allow for ankle plantarflexion?

Answer 20

S1/2

Question 21

What are the 2 nerve irritaion tests?

Answer 21

Sciatic stretch test

Femoral nerve test

Question 22

What specialised investigations are used for back pain?

Answer 22

MRI - BUT BEWARE
Diagnostic facet injection
Contrast CT
Provocation discography 
Selective nerve block

Question 23

What is sciatica?

Answer 23

Buttock or leg pain in a specific dermatomal distribution accomapined by neurological distribution

Question 24

What is the common presentations of disc prolapse?

Answer 24

Episodic back pain
Onset of leg pain
Myotomes and dermatomes

Question 25

How is backache treated?

Answer 25

Short bed rest Anti-inflammatory +/- muscle relaxant Mobilise thereafter Physical therapy

Question 26

What are red flag symptoms point to cauda equina syndrome?

Answer 26

Dysfunction of baldder, bowel or sexual function | Sensory changes in saddle or perianal area

Question 27

What reg flag symptoms point to discitis/ infection?

Answer 27

Sudden onset of acute spinal pain or suspicioud change in pattern, no history of trauma Systemic signs; fever, high pulse Night pain All spinal movements grossly restricted by pain and spasm

Question 28

What red flag symptoms point to an inflammatory spondyloarthropathy?

Answer 28

Morning stiffness and backache or multiple joint problems Generally inwell Associated skin rash, IBD, eye problems, urethritis, SIJ pain

Question 29

What conditions should be referred to a spinal specialist?

Answer 29

Lumbar disc prolapse with uncomplicatied sciatica Lumbar spinal stenosis Mechanical back pain

Question 30

What spinal conditions are emergencies?

Answer 30

Cauda equina syndrome | Fracture with deteriorating neurology

Question 31

What should the x-ray show for a C spine?

Answer 31

Make sure shows C7/T1

Question 32

Where are the most common thoracolumber injuries?

Answer 32

T12 or L1

Question 33

In what ways can the spinal cord be involved in a pathology?

Answer 33

Size of spinal canal Location of injury Bone pinching Contact pressure

Question 34

What can cause a secondary cord damage?

Answer 34

``` Cord swelling Oedema Ischaemia Thrombosis of small vessels Venous obstruction ```

Question 35

What is a complete cord injury?

Answer 35

Complete severing of spinal cord

Question 36

What will cause a central cord injury?

Answer 36

Typical hyperextension injury Arms worse than legs Prognosis variable

Question 37

What are the symptoms of a brown sequard injury?

Answer 37

Paralysis on ipsilateral side | Hypaesthesia on contralateral side

Question 38

What symptoms will an anterior cord injury cause?

Answer 38

Motor loss Loss of pain and temp sense Deep touch, position and vibration preserves

Question 39

What deformities can scoliosis cause?

Answer 39

Rotational component Lateral bend component Rib deformaties Visceral abnormalities

Question 40

What are the different types of scoliosis?

Answer 40

Congenital Early onset idiopathic Late onset idiopathic Secondary

Question 41

What causes a congenital scoliosis?

Answer 41

Imbalance in the number of growth plates and the greater the imbalance the worse the deformity

Question 42

What is heuter-volkmann's law?

Answer 42

Increased pressure across an epiphyseal plate inhibits growth

Question 43

What can produce a secondary scoliosis?

Answer 43

Neuromuscular Tumours Spina Bifida

Question 44

What are the non-operative managments of scoliosis?

Answer 44

Serial corrective casts Bracing Corrective exercises Electrical simulation

Question 45

What is kyphoysis?

Answer 45

Centre of gravity anterior to spine | Opposite of scoliosis

Question 46

What are the yellow flags for chronic back pain?

Answer 46

``` Low mood High levels of pain Belief that activity is harmful Low educational level Obesity Problem with compensation Job dissatisfaction Light duties not avaliable at work Lots of lifting at work ```