Final Scraps for Exam 1 Flashcards
Current recommendations suggest clinicians conduct a focused hx and physical exam to classify pts into 1 of 3 categories:
Diagnostic triage!
- Non-specific LBP
- LBP with potential radiculopathy or spinal stenosis
- LBP potentially due to serious spinal pathology (i.e. Tumor, infection, AS)
What are the things you’d want to rule out for serious spinal pathology?
- Cancer
- Spinal fx
- Infection
- Abdominal aortic aneurysm
- Kidney or urinary disorders
- Cauda equina
- Vascular claudication
- Ankylosing spondylitis
Absence of these 4 essentially rules out cancer
- Previous hx of non-skin cancer
- Failure of conservative tx in last month
- Age over 50
- Significant unexplained WL in the past 6 months
These lab values might indicate high likelihood of cancer
- ESR
- hematocrit under 30%
- anemia
- WBC over 12000
What are 5 characteristics that make spinal fx more likely?
- age over 50
- female
- major trauma
- pain and tenderness
- a distracting painful injury
What is the cause of spinal fx in gymnasts typically?
Microfracture
Corticosteroid use and spinal fx
- decreased bone density
- increased risk for OP related fx
In the absence of major trauma, vertebral fx present so similarly to these that only 30% are identified in clinical practice
Acute nonspecific LBP
Infection: Does lack of fever rule this out?
No: lack of fever does not significantly decrease the odds of infection
Risk factors for AAA
- family hx
- heart stuff
- cerebrovascular disease
- increased height
Decreased risk for AAA
- female
- DM
- African American
Presentation of AAA
- highly variable
- 75% are asymptomatic
- may report low t-spine, lumbar, abdominal, hip, or buttock pain
- not usu a cause of LBP
What would clue you in to kidney or urinary issues as a source of LBP?
- unilateral flank pain
- low ab pain above pubic bone
- may have pain radiating to groin
- difficuly initiating urination (or pain)
- blood in urine
- UTI hx
CES onset
- sudden OR
- progress quickly over a few hours or 1-2 days
Requires surgery within 48 hours
Most common cause of CES
- Large, midline posterior disc herniation, commonly at L4-5 or L5/S1
Other causes of CES
- spinal stenosis
- spinal tumor
- infection
- fx
S/s of CES
- changes in b/b
- saddle paresthesia/anesthesia
- unilateral or bilateral sciatica
- hard neuro signs (most common over butt, post/sup thighs, perineal)
- abn passive SLR
Vascular claudication is usually a symptom of:
PVD
Vascular claudication is caused by:
Insufficient blood flow to the LE
Vascular claudication can mimic
Neurogenic claudication
When do sx increase with vascular claudication?
- same distance each time
- walking uphill or up stairs
What decreases sx of neurogenic claudication?
- walking uphill
- sitting
- flexed spinal position
What things may make you suspect PVD?
- cool skin
- presence of at least one bruit
- palpable pulse abnormality
With AS, when does back pain improve?
Improves with exercise, but not with rest
