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Flashcards in FN: Back Pain Deck (22):
1

Red Flags

1. Age 55 yrs
2. Neurological disturbance (inc. sciatica)
3. Spincter disturbance
4. Bilateral or alternating leg pain
5. Current or recent infection
6. Fever, wt. loss, night sweats
7. History of malignancy
8. Thoracic back pain
9. Morning stiffness
10. Acute onset in elderly people
11. Constant or progressive pain
12. Nocturnal Pain

2

Cause of back pain

Mechanical
Degenerative
Inflammatory
Neoplasm
Infection

3

Mechanical causes

Strain/idiopathic
Trauma
Pregnancy
Disc polapse
Spondylolisthesis

4

Degenerative causes

Spondylosis
Vertebral collapse
Stenosis

5

Inflammatory

Ank SPond
Pagets

6

Neoplasm

Mets, myeloma
Thyroid
Bronchus
Breast
Kidney
Prostate

7

Infection

TB
Abcess

8

L2 lesions causes weakness where

Hip flexion and adduction

9

L3 lesions causes

weakness in knee extension and hip adduction
Reflex - knee jerk

10

L4 lesions

Foot inversion and dorsiflexion
Knee extension
Knee jerk reflex

11

L5 lesion

Great toe dorsiflexion
Foot inversion and dorsiflexion
Knee flexion
Hip extension and abduction

12

Si lesion

Foot eversion
Foot and toe plantar flexion
Knee flexion
ankle jerk

13

Investigations

Usually only neccessary if red flags present
FBC, ESR, CRP, ALP, se electrophoresis, PSA
MRI

14

Management

Neurosurgical referral if neurology needed
Conservative
Medical
Surgical

15

Conservative

Max 2 day bed rest
Education- Keep active, how to lift/stoop
Physio
Pyschosocial issue re. chronic pain and disability
Warmth

16

Analgesia: paracetamol and NSAIDS and codeine

Muscle relaxant: low-dose diazepam (short-term)
Facet joint injections

17

Surgial

Decompression
Prolapse surgery: e.g. microdescectomy

18

acute cord compression

Bilateral pain: back and radicular
LMN signs at compression level
UMN signs and sensory level below compression
Spincter disturbance

19

Acute Cauda Equina compression

Alternating or bilateral radicular pain in the legs
Saddle anaesthesia
Loss of anal tone
Bladder and bowel disturbance

20

Large prolapse treatment

Laminectomy
Discectomy

21

Tumour treatment

Radiotherapy and steroids

22

Abscesses

Decompression

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