Back Pain Flashcards by Louise Emerson

what are the five categories of back pain

viscerogenic
spondylogenic (originates in spinal chord and its associated structures)
discogenic  
neurogenic 
psychogenic

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what are abdominal causes of back pain

AAA
renal colic 
pancreatitis 
peptic ulcer disease
gallbladder
uterine/ovarian
colonic

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describe root leg pain

dermatomal distribution, sharp, shooting, below knee, anatomical sensory and motor symptoms

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what type of pain in sciatic

root pain

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describe referred leg pain

down to back of knee- not below it, dull, gnawing, buttock, thigh, ill defined sensory symptoms

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what are red flags of back pain

neurological- bowel/ urinary: incontinence, loss of control/ awareness. perineal/ saddle anaesthesia. bilateral/ unilateral/ no leg symptoms. paraesthesia, numbeness and weakness

no mechanical pain (doesnt vary with activity, worse at night

systemic upset

major, new, neurological deficit

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what are 4 possible spine pathologys causing pain

fracture
tumour
infection
inflammatory conditions (e.g. AS)

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what are the most common spine cancers

usually secondary

most common primary is myeloma

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what cancers metastasise to bone

(bad little boys pee through kidneys)

breast, lungs, bronchus, prostate, thyroid, kidney

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what are the local effects of spine infection

destruction of vertebrae, collection of pus

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what condition most commonly predisposes spinal fractures

osteoporosis

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what other feature might suggest cancer

weight loss, fatigue, anaemia, insidious onset of pain, night pain

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what tends to cause nerve root problems

a protuding disc

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what direction do discs usually protrude and what nerves do they affect

come out posterolaterally

affect traversing nerve (e.g. disc between L5 and S1 protrusion will affect nerve S1)

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what can lead to a disc prolapse

impaired disc nutrition making it prone to damage by load, torsion, shear= disc fissure

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what are the different types of disc prolapse

protrusion- prolapse contained by posterior ligament

extrusion- defect in annulus fribosus, usually not contained

sequestration- disc goes out into canal

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what causes pain in a disc prolapse in the large vertebral canal

back pain from stretch annulus/ posterior long ligament

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what causes pain in a disc prolapse when the vertebral canal in small

root compression, raised inflammatory markers,

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what does loss of disc height (normal with ageing) cause

facet arthropathy (facet joints become maligned)= back pain +/- canal stenosis

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what types of back pain can degenerative back pain cause

MBP- osteoarthritis, facet arthropathy

NRP- stenosis (osteophyte formation) or narrowing (loss of disc height)

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what is the management for MBP

non surgical- physio

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what is spondylolostheisis

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when vertebrae slips forward onto bone beneath it (enabled by a fracture or defect)

what is spondylolysis

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stress fracture/ defect in the pars interarticularis of vertebral arch

what do you look for in observation of the back and side in examination

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deformity, asymmetry, hairy patches, neurofibromata, sometimes muscle spams

name two things that can cause loss of lumbar lordosis

AS or spasm

what will forward bending accentuate

structural deformity e.g. rib hump in scloliosis

what classifies as pathologically stiff in schobers test

less than 18cm

what problems might be exacerbated with hyperextension of spine

facet arthropathies

What are the types of nerve irritation tests

straight leg raised + variants for sciatic nerve femoral stretch for femoral roots

what myotome for hip flexion

L1/2

what myotome for knee extension

L3/4

what myotome for foot dorsiflexion and extensor hallucis longus

what myotome for ankle plantarflexion

S1/2

what does scaitic nerve irritation test

tight hamstrings nerve irritation when you lift leg up straight with foot flexed and get a shooting pain radiating down the dermatome. drop leg until pain goes then dorsiflex foot and if pain comes back sciatic nerve irritation

how do you do a femoral stretch

extend hip, flex the knee

what is overt pain behaviour

``` guarding bracing rubbing grimacing sighing ```

what is a non anatomical pain

reflex behavioural response

what is a straight leg raise distraction test useful for

people exaggerating their problem

when should you do a rectal exam

spinal pathology or any possible suggestion of cauda equina syndrome

what are the specialised spinal investigation

MRI (76% false positive) diagnostic facet injection contrast enhanced CT- myelogram provocation discography selective nerve block/ ablation

what is a high intensity zone on MRI

white area- seen in e.g. annular tear

what will a patient think sciatica is

vague buttock or leg pain

what is sciatica

buttock and/ or leg pain in a specific dermatomal distribution accompanied by neurological disturbance

what is the surgery for a disc prolapse used to treat

leg pain not back pain

what is the common presentation of a disc prolaspe

episodic back pain onset of leg pain +/- neurology leg pain becomes dominant myotomes and dermatomes

only when is a disc prolapse a surgical emergency

if there is cauda equina symptoms most settle without surgery in 3-24 months

what is the treatment for disc prolapse

conservative treatment, consider therapy if not resolving after 3 months

what is the management for back ache

conservative treatment - short bed rest - anti inflammatory +/- muscle relaxant - mobilise thereafter (fast, acitve rehab) - physical therapies - x rays (only if severe) - return to normal activity education physio/osteopathy/chiropractic TENS/ psychology/ pain clinic surgery

what are BAD managements of backache

``` bed rest bed rest with traction narcotics > 2 weeks benzodiazepines >2 weeks steroids plaster jacket manipulation under general anaesthetic ```

what markers are often raised in bone disease

calcium and alkaline phophatase

what is spinal claudication

when narrowing of spinal canal causes symptoms like vascular claudication but not as severe and often helped by bending forward

when should you do an MRI for back pain

only if red flags or considering surgery

what is seen on x ray of osteoarthritis

``` loss loss of joint space osteophytes sclerosis subarticular cysts ```

what are the yellow flags for chronic back pain

``` low mood high levels of pain/ disability belief that activity is harmful low education level obesity problem with claim/compensation (secondary gain) job dissatisfaction light duties not available at work lot of lifting at work ```

Back Pain Flashcards

(54 cards)