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MSK lectures > Backpain 16/10/18 > Flashcards

Backpain 16/10/18 Flashcards

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1
Q

How are back problems assessed?

A 
History
Examination
Social factors
Occupational factors
Litigation
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2
Q

What are causes of back pain?

A

Viscerogenic
Spondylogenic
Discogenic
neurogenic

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3
Q

What is a viscerogenic cause of back pain?

A

AAA

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4
Q

What are some other abdominal causes of back pain?

A 
Gallbladder
Pancreatic
Renal
Peptic ulcer
Colonic 
Uterine
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5
Q

What are the symptoms of back pain?

A

Back pain
Leg pain
Neurological symptoms

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6
Q

What are two types of back pain?

A

Mechanical

Non-Mechanical

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7
Q

What are 3 presentations of back pain?

A

PSP - Possible spinal pathology
NRP - nerve root pain
MBP - MEchanical backpain

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8
Q

Back pain history?

A

SOCRATES

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9
Q

What are the two types of leg pain?

A

Referred

Root

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10
Q

What pattern does nerve root pain follow?

A

Dermatomal distribution

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11
Q

What type of pain is referred pain?

A

Dull
Buttocks/thigh
Rarely below knee
Ill defined sensory symptoms

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12
Q

What type of pain is root pain?

A

Sharp
Invariability below knee
Anatomical sensory/motor symptoms

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13
Q

What is sciatica?

A

ROOT leg pain

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14
Q

What are neurological symptoms associated with back pain?

A

Incontinence/loss of control or awareness
Perineal/saddle numbness
Bilateral/unilateral
Can have no leg ymptoms

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15
Q

What additional information is useful in back pain history?

A

Social
Age
Occupational factors
Litigation

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16
Q

what are some red flag signs for back pain?

A 
Non-mechanical pain
Systemic upset
New neurological deficit
Saddle anaesthesia
Bladder or bowel upset
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17
Q

What are some possible spinal pathologies which can cause back pain?

A

Fracture
Tumours (secondary metastatic tumours)
Infection
Inflammatory - Ankylosing spondylitis

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18
Q

What cancers commonly metastasize to bone?

A 
Breast
Lung
Renal 
Thyroid 
Kidney
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19
Q

What is the most common primary tumour in the spine?

A

Myeloma

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20
Q

what is the most common cause of fractures in the spine?

A

Osteoporotic

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21
Q

What features of a history would indicate at a tumour?

A 
Weight loss
Fatigue
Bowel symptoms
Renal symptoms
Insidious onset
No identifiable event
Constant
Night pain
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22
Q

What features f a history would indicate an infection?

A

Infection
Temperature
Fever
History of foreign travel

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23
Q

Have a look at a nerve root diagram because i have no fucking clue what is going on

A

xoxo gossip girl

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24
Q

what is the pathogenesis of disc prolapse?

Study These Flashcards
A

Impaired disc nutrition
Disc prone to damage
Disc fissure - free fragments
Protrusion, extrusion, sequestration

25
What can accomodate a disc prolapse?
A large vertebral canal
26
What happens when a prolapse occurs in a small vertebral canal?
Root compression Inflammatory markers Root pain Tension signs
27
What is the treatment for small vertebral canal disc prolapse?
Resolution | Surgery
28
What is the end result of acute disc prolapse?
Loss of disc height Facet arthropathy Back pain +/- Canal Stenosis
29
What does degenerative disc disease cause?
Back pain | Stenosis or narrowing
30
When is back pain mechanical?
Diagnosis of exclusion No nerve root problem No underlying pathological process
31
What are some sources of back pain?
Sacroiliac joint Facet joints Muscle tears
32
What 2 conditions can cause mechanical back pain?
Spondylolysis | Spondylolisthesis
33
Where does spondylolisis occur?
Stress break along the transverse process of the vertebral body
34
What is looked for on back pain examination?
Straightness of spine | Forward bending
35
What is the normal profile of the spine?
Cervical Lordosis Thoracic Kyphosis Lumbar Lordosis
36
What can cause loss of lumbar lordosis?
Scoliosis | Ankylosing spondylitis
37
What 4 things are assessed on neurological examination?
Myotomes Dermatomes Reflexes Nerve irritation
38
What are the respective myotomes for Hip, knee, foot and ankle movements?
L1/2 - Hip flexion L3/4 - Knee extension L5 - Foot dorsiflexion S1/2 - Ankle plantarflexion
39
What does the straight leg raise test show?
Ability to burlesque | nerve root irritation - shooting pain
40
What is pain drawing?
The patient marks on a picture where they are experiencing pain
41
What is overt pain behaviour?
``` Guarding Bracing Rubbing Grimacing Sighing ```
42
What are behavioural responses to examination (Waddell)?
``` Superficial/Non anatomical tenderness Simulation - axial loading/rotation Distraction - SLR Over-reaction to examination Regional - sensory disturbance ```
43
What is a distraction test?
Get the patient to do a movement where they aren't thinking about it that proves they are fine - Can't do straight leg test - Ask them to sit up
44
What is an important examination to do in patients that have back pain?
PR examination
45
When is a PR examination appropriate?
Cauda equina syndrome
46
Are x-rays useful in back pain?
No in 99% of cases
47
When would a plain back x-ray be needed?
Worried about a PSP
48
Are MRI useful?
Not the answer Mostly false positive Double edged sword
49
What investigations are used to diagnose backpain?
``` MRI - but be careful` Diagnostic facet injection Contrast enhanced CT Provocation discography Selective nerve block/ablation ```
50
What is the spinal surgeon's definition of sciatica?
Buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance
51
When is surgery done for disc prolapse?
Only done for leg pain
52
Will disc prolapse surgery improve neurology symptoms?
Not sure | Unpredictable
53
What are common presentations of disc prolapse?
Episodic back pain Onset of leg pain +/- neurology Leg pain becomes dormant Myotomes and dermatomes
54
Is disc prolapse an emergency?
No
55
How long will disc prolapse take to heal?
70% in 3 months | 90% in 18-24 months
56
When is disc prolapse surgery required?
Suffering severly | Not healing within 3 months
57
How is backache managed?
``` Short bed rest Anti-inflammatory Muscle relaxant Mobilise Physical therapies Return to normal activities ```
58
What is the second line treatment for backache?
``` Education Physiotherapy osteopathy TENS Complementary therapies Surgery ```
59
Look at the back pain pathways
xoxo gossip girl

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