Back Pain and Problems Flashcards Preview

The Musculoskeletal System > Back Pain and Problems > Flashcards

Flashcards in Back Pain and Problems Deck (61):
1

What may be some suspicious features, or red flags, of back pain?

  1. Systemic upset - Fevers, night sweats, weight loss, fatigue and malaise
  2. New back pain in the elderly (>60)
  3. Back pain in the young (<20)
  4. Pain which is constant, severe or worse at night
  5. Saddle anaesthesia
  6. Bladder/bowel upset
  7. History of cancer (any)
  8. ​History of steroids

2

What is saddle anaesthesia?

Loss of sensation restricted to the area of the buttocks, perineum and the inner thighs

3

What does testing the L1/2 myotome involve?

Hip flexion

4

What does testing the L3/4 myotome involve?

Knee extension

5

What does testing the L5 myotome involve?

Foot dorsiflexion

6

What does testing the S1/2 myotome involve?

Ankle plantarflexion

(It can often be hard to pick up weakness here, a good way to test is to ask the patient to go on their tip toes)

7

What is the gold standard investigation for back pain?

MRI

8

What is the problem with using MRI for back pain?

It can result in many false positives

Abnormalities are common, but they often don't cause any problems

9

What is a diagnostic facet injection?

An injection of steroids in the facet joint to test if there is improvement

10

On MRI, what is the appearance of disc inflammation?

Hamburger appearance

11

What is sciatica?

Buttock and/or leg pain in a specific dermatomal distribution coupled with neurological disturbance of the L4, L5 or S1 nerve roots

Pain radiates to the sensory aspect of the sciatic nerve

12

When surgery is undertaken for a prolapsed disc, what is the aim of the surgery?

To reduce leg pain

13

Why will surgery only be considered after 3 months of no improvement for a prolapsed disc?

  1. There is no long term benefit so rushing into surgery is pointless
  2. The patient must get back to work as their life will be impacted after 3 months
  3. There are risks to surgery so it should not be rushed into
  4. Most (70%) cases settle by themselves within 3 months

 

14

What is the first line management of a prolapsed disc and associated back pain?

  • Short bed rest - only when really required
  • Anti-inflammatories +/- muscle relaxant (diazepam)
  • Early mobilisation (potentially with physio)
  • Return to normal activity
  • Education

15

What is the second line management of back pain associated with a prolapsed disc?

  • Physiotherapy
  • Osteopathy/chiropractor
  • TENS/psychologist/pain clinic
  • Complementary therapies
  • Surgery (rare)

16

Why is cauda equina syndrome an emergency?

There may be limited time (<48 hours) to treat

17

How must spinal fractures be dealt with initially?

  • Immobilise
  • X-ray
  • Deal with other injuries

18

How can secondary spinal cord damage occur?

  • Swelling
  • Oedema
  • Ischaemia
  • Thrombosis of small vessels
  • Venous obstruction

19

What are the 2 main patterns of spinal cord injury?

  1. Complete
  2. Incomplete

20

What are the three main types of incomplete spinal cord injury?

  1. Brown-Sequard
  2. Central cord injury
  3. Anterior cord injury

21

How does a central spinal cord injury typically occur?

Forced hyperextension

 

22

Anterior cord injuries are usually seen after what?

Vascular insult

23

What are the worst problems that cause secondary damage to a spinal cord?

  1. Hypoxaemia
  2. Hypotension

Also:

  • Stretching
  • Compression
  • Undue movement
  • Inappropriate surgery
  • Infection

24

How should ankylosing spondylitis be initially managed?

  • Immobilise in natural position (no collars)
  • Mandatory CT

25

What are the 4 types of scoliosis?

  1. Congenital
  2. Early onset
  3. Late onset
  4. Sencondary

26

What is Heuter-Volkmann's law?

Increased pressure across an epiphyseal growth plate inhibits growth

27

Secondary scoliosis can result from what?

  • Neuromuscular problems
  • Tumours
  • Cerebral-palsy
  • Spina bifida

28

What is spondylolysis?

Defect in the pars interarticularis of vertebrae

29

What is spondylolisthesis?

Forward slippage of one vertebrae onto another

30

What is mechanical back pain?

Recurrent relapsing and remitting back pain with no neurological symptoms

31

What are causes of mechanical back pain?

  1. Obesity
  2. Poor posture
  3. Poor lifting technique
  4. Lack of physical activity
  5. Depression
  6. Degenerative disc prolapse
  7. Factet joint OA
  8. Spondylosis

32

What is spondylosis?

Intervertebral discs lose water content with age which causes less cushioning and secondary OA due to increased facet joint pressure

33

What is the main treatment for mechanical back pain?

Analgesia

Physiotherapy

34

When would spinal stabilisation surgery be indicated for mechanical back pain?

  1. A single level is affected by OA or instability
  2. The pain has not improved despite physio and conservative management
  3. There are no secondary gains from surgery e.g. compensation claim

35

When does an acute tear in the out annulus fibrosis typically occur?

Heavy lifting

36

When there is a tear in the annulus fibrosis of a intervertebral disc, when is the pain characteristically worse?

When coughing

37

Why is pain severe with acute disc tear?

The periphery of the disc is richly innervated

38

What are the mainstay of treatment for acute disc tear?

Analgesia and physiotherapy

39

The nucleous pulposus may herniate through a tear in the annulus fibrosis which can impinge on nerve roots causing what?

  1. Pain in a dermatomal distribution
  2. Reduced power in a myotomal distribution

40

Where are the most common sites for disc heriation/prolapse to occur?

L4, L5 and S1 nerve roots

41

How can the radicular pain in disc prolapse be described?

Neuralgic burning or severe tingling pain whichradiates to the back of the thigh to below the knee

42

An L3/4 disc prolapse leads to __ root entrapment which causes pain down to the _________ _________, loss of power to which muscles and a reduction in which reflex?

L4

Medial ankle

Quadriceps

Knee jerk

43

An L4/5 disc prolapse leads to __ root entrapment which causes pain down to pain down the _________ of the foot and loss of power to which muscles?

L5

Dorsum

Extensor hallucis longus and tibialis anterior

44

An L5/S1 disc prolapse leads to __ root entrapment which causes pain down to the _________ of the foot, loss of power _________ and a reduction in which reflex?

S1

Sole

Plantarflexion

45

What are the treatment options for sciatia?

  1. Analgesia
  2. Maintaining mobility
  3. Physiotherapy
  4. Drugs for neuropathic pain (gabapentin, pregabalin, amitriptyline)
  5. Surgery (for very few cases)

46

Why does OA sometimes lead to sciatica?

Osteophyte formation can result in osteophytes impinging on nerve roots causing sciatica

47

What is the treatment for OA induced sciatica?

Surgical decompression with trimming of impinging osteophytes

48

What is spinal stenosis?

Narrowing of the spinal canal due to a bulging ligamentum flavum, osteophytes, bulging discs atc

49

Which age of patient is most likely to suffer from spinal stenosis and what is the classic complaint?

60

Pain in legs when walking (claudication)

50

How is claudication induced by spinal stenosis different from claudication induced from PVD?

  1. The claudication distance is inconsistent
  2. The pain is burning rather than cramping
  3. Pain is less when walking uphill as this creates more space in the spinal canal
  4. Pedal pulses are preserved (dorsalis pedia, tibialis posterior)

51

When may surgery be indicated for spinal stenosis?

  1. When conservative management fails e.g. weight loss, physiotherapy, analgesia
  2. There is MRI evidence of stenosis

52

What causes cauda equina syndrome?

A very large central disc prolapse which compresses all the nerve roots of the cauda equina

53

Why is cauda equina syndrome an emergency?

The affected root control urination and defaecation

Prolonged compression can cause permanent nerve damage 

54

What are the classic signs of cauda equina syndrome?

  1. Bilateral leg pain
  2. saddle anaesthesia
  3. Urinary retention is more common than incontinence
  4. Faecal incontinence/constipation

55

Which tests are essential in a patient with suspected cauda equina syndrome?

  1. Rectal examination (PR) 
  2. MRI (determines level of prolapse)

56

New back pain in people over 60 is considered a red flag, why is this?

Older people are at higher risk of neoplasia, especially metastatic disease and multiple myeloma

57

Pain from tumour of infection tends to be described in what way?

  1. Contant
  2. Unremitting
  3. Severe
  4. Worse at night

58

If there is any suspection of tumour or infection behind the cause of back pain which tests are required?

  1. Thorough history
  2. CRP, FBC, U&Es
  3. Bone biochemistry
  4. Plasma protein electrophoresis
  5. PSA for males
  6. Blood culture
  7. CXR
  8. Bone scan
  9. MRI

59

In patients with severe osteoporosis, which fractures may occur to the vertebral body?

Spontaneous crush fractures

60

Spontaneous crush fractures to the vertebral body as a result of osteoporosis can lead to what?

  1. Acute pain
  2. Kyphosis

61

What are the treatment options for osteoporotic crush fractures?

Conservative

Balloon vertebroplasty (trial treatment, involving inserting balloon into vertebrae to bring cortices together and then injecting bone cement to recreate original bone structure)

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