Backache and Spinal Deformity Flashcards by Joanne McEwan

what are some types of causes of back pain?

viscerogenic
spondylogenic
discogenic
neurogenic
psychogenic

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name a serious viscerogenic cause of back pain?

abdominal aortic aneurysm

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abdominal causes of back pain?

renal
pancreatitis
some gall bladder symptoms
peptic ulcer disease
uterine/ovarian
colonic

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presenting symptoms of a back problem?

back pain
leg pain
neurological symptoms

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2 types of back pain?

mechanical

non-mechanical

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3 presentations of back pain?

possible spinal pathology
nerve root pain
mechanical back pain

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Qs to ask in back pain?

SOCRATES

was there as precipitating incident? (cough, injury, lifting etc)

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2 types of leg pain?

referred

root pain

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where does nerve root pain distribute?

dermatomal

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describe referred pain?

dull
posterior thigh and buttock
rarely below the knee
ill defined sensory symptoms

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root pain?

sharp shooting pain
invariably below the knee to foot and ankle
anatomical sensory/motor symptoms

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is sciatica root or referred pain?

root

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give a neurological symptoms of back pain?

bowel/urinary

incontinence/loss of control or awareness
perineal/saddle anaesthesia
bilateral/unilateral/no leg symptoms

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give another 3 neurological symptoms

parasthesia
numbness
weakness

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are neurological symptoms red flag signs?

yes

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what non medical things must be considered in a history?

litigation
social
age
occupation

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name 4 red flags

non-mechanical pain
systemic upset
major, new neurological deficit
saddle anaesthesia +/- bladder or bowel upset

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name 4 red flags

non-mechanical pain
systemic upset
major, new neurological deficit
saddle anaesthesia +/- bladder or bowel upset

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give some possible spinal pathologies which can cause back pain

fracture (often Osteoporosis associated)
tumours (usually mets)
infection
inflammatory (AS)

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what cancers commonly metastasise to bone?

Bad - breast
Boys - bronchus (lung)
Pee - prostate
Through - Thyroid
Kidneys - renal

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what is the most common primary tumour in the spine?

myeloma

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what in a history suggests a tumour?

weight loss
fatigue
anaemia
insidious onset (no precipitating event)
fairly constant pain (night pain)

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what features of history would indicate an infection?

high temp
fever
recent foreign travel

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pathogenesis of disc prolapse?

disc loses water in ageing > disc prone to damage by load, torsion, shear > disc fissure > prolapse, extrusion, sequestration > compression of nerve roots (depending on vertebral canal) > pain etc > loss of disc height and facet arthropathy

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what is a protrusion?

where the IV disc is intact but bulges out when under pressure

what is an extrusion?

where the outer annulus fibrosis ruptures, allowing the inner nucleus pulposis to bulge out

what is a sequestration?

where the outer annulus fibrosis ruptures, allowing the nucleus pulposis to bulge through and a piece of the nucleus breaks off

how can the diameter of the vertebral canal affect pain?

large space = can accommodate disc prolapse etc and wouldn't cause sciatica/leg pain small space = not enough room so nerve roots get compressed by e.g prolapsed disc and will cause sciatica/leg pain etc

what physiological changes can occur in disc prolapse over time?

loss of disc height facet arthropathy - can collapse back pain +/- canal stenosis

what is degenerative disc disease?

loss of IV disc structure (water) in ageing | can loose height can cause stenosis

how can degenerative disc disease cause narrowing of the vertebral foramen?

facet joints made for a certain disc height so when this is lost they don't really fit together causing the vertebral canal to narrow

most common back pain?

mechanical

how is mechanical back pain diagnosed?

by exclusion no nerve root problem no underlying pathological process

2 uncommon causes of mechanical pain?

spondylolysis | spondylolisthesis

what is spondylolysis?

linear crack in pas interarticularis | looks like a collar on the dog shape of vertebra

what is spondylolisthesis?

break in pas interarticularis allowing vertebra to slide

examination of back pain?

``` observation range of movement neurological assessment nerve root irritation distraction testing ```

observation features of spine?

straight spine kyphosis/lordosis scapula/iliac crest symmetrical

what can cause loss of lumbar lordosis?

scoliosis | ankylosing spondylitis

what can cause a bulging out on one side on forward bending?

scoliosis

what does extension of the spine show function of?

facet joints

what are the myotomes?

L1/2 = hip flexion L3/4 = knee extension L5 - foot dorsiflexion S1/2 = ankle plantarflexion

what 4 things are tested on neurological examination?

myotomes dermatomes reflexes nerve irritation

what 3 reflexes are tested?

knee jerk ankle jerk plantar reflex

how is nerve irritation tested?

straight leg test | would produce shooting pain along the dermatome

what is pain drawing?

where the patient marks on a picture where their pain in | can show whether dermatomal, non-anatomical etc

what is overt pain behaviour?

how the patient reacts in response to their pain - guarding - bracing - rubbing - grimacing - sighing

waddell behavioural responses?

``` superficial/non-anatomical tenderness simulation distraction over-reaction to examination regional - sensory disturbance, giving way ```

what is a distraction test?

if a patient claims they cant perform a straight leg test because of pain, ask them to sit upright and they will do it fine - shows they are exaggerating pain

important examination to determine cause for back pain?

PR exam | - altered sensation around anus or loss of anal sphincter tone can suggest cauda equina problem

are X rays useful in diagnosis of mechanical back pain?

no (in most cases)

when would an X ray be useful in mechanical back pain?

if you suspect spinal pathology

is an MRI diagnostic?

no | can confirm a previously though diagnosis or locate it but can give false positives

what specialised investigations are used in mechanical back pain?

``` MRI (beware) diagnostic facet injection Contrast enhanced CT provocation discography selective discography selective nerve block/ablation ```

what is sciatica?

any sort of buttock or leg pain not obviously coming from hip, knee or ankle in a specific dermatomal distribution accompanied by neurological disturbance - root leg pain

when is surgery performed in disc prolapse?

only for leg pain | not for back pain

does disc prolapse surgery improve neurology symptoms which are associated?

unpredictable | can often not regain reflexes

common presentations of disc prolapse?

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

how is disc prolapse treated?

not an emergency as 90% resolve within 18-24 months | only treated with surgery if cauda equina or consider surgery if it doesn't settle within 3 months

how is backache managed conservatively?

short bed rest (debatable) anti inflammatory +/- muscle relaxants mobilisation physiotherapy

second line treatment for backache?

``` education/reassurance etc physiotherapy osteopathy TENS/psychology surgery ```

Backache and Spinal Deformity Flashcards

(61 cards)