LBP

Question 1

Back pain accounts for at least_______ of all presenting
problems in general practice in Australia and 6.5%
in Britain.

Answer 1

5%

Question 2

The most common cause of back pain is a _______ but people
suffering from this type of back pain usually do not
seek medical treatment as most of these soft tissue
problems resolve rapidly

Answer 2

minor

strain to muscles and/or ligaments,

Question 3

The main cause of back pain presenting to the
doctor is dysfunction of the intervertebral joints
of the spine due to injury, also referred to as
__________

Answer 3

mechanical back pain (at least 70%).

Question 4

The second most common cause of back pain is
________(synonymous with osteoarthritis and
degenerative back disease). It accounts for about
10% of cases of low back pain

Answer 4

spondylosis

Question 5

L5 and S1 nerve root lesions represent most of the

cases of_________presenting in general practice.

Answer 5

sciatica

Question 6

what is the cause of disruption of the intervertebral disc in the cause of
back pain

Answer 6

minor intervertebral

derangement (MID).

Question 7

The MID always involves _________ in the mobile segment, thus
initiating nociceptive activity in the posterior primary
dermatome and myotome.

Answer 7

one of the two

apophyseal joints

Question 8

In theory, any structure with a nociceptive nerve
supply may be a source of pain. Such structures
include the______

Answer 8

ligaments, fascia and muscles of the
lumbosacral spine, intervertebral joints, facet joints,
dura mater and sacroiliac joints.`

Question 9

This term has been introduced to identify psychosocial
and occupational factors that may increase the risk of
chronicity in people presenting with acute back pain

Answer 9

Yellow flag pointers

Question 10

What are the Yellow flag pointers for LBP

Answer 10

• abnormal illness behaviour
• compensation issues
• unsatisfactory restoration of activities
• failure to return to work
• unsatisfactory response to treatment
• treatment refused
• atypical physical signs

Question 11

Pain characteristics

• \_\_\_\_\_\_\_\_\_ = inflammation (e.g.
sacroiliitis)
•\_\_\_\_\_\_\_\_\_\_\_= referred pain (e.g.
dysmenorrhoea)
•\_\_\_\_\_\_\_\_\_ = local pain (e.g.
muscular strain)

Answer 11

aching throbbing pain

deep aching diffuse pain

superficial steady diffuse pain

Question 12

Pain characteristics

•_______ = bone disease (e.g. neoplasia,
Paget disease)
•________ = radicular pain (e.g. sciatica)

Answer 12

boring deep pain

intense sharp or stabbing (superimposed on a
dull ache)

Question 13

Continuous pain, present day and night, is

suggestive of _____ or ______

Answer 13

neoplasia or infection

Question 14

Pain on waking also suggests _______

Answer 14

inflammation or depressive illness

Question 15

Pain provoked by activity and relieved by rest suggests
_________ while pain worse at rest and
relieved by moderate activity is typical of ____

Answer 15

mechanical dysfunction

inflammation.

Question 16

Pain aggravated by standing or walking that is
relieved by sitting is suggestive of_______
Pain aggravated by sitting (usually) and improved
with standing indicates a _______

Answer 16

spondylolisthesis.

discogenic problem

Question 17

Pain of the calf that travels proximally with walking
indicates _______; pain in the buttock
that descends with walking indicates _____

Answer 17

vascular claudication

neurogenic claudication

Question 18

A useful screening test for a disc lesion and dural

tethering is the______

Answer 18

slump test

Question 19

active movements in PE

Answer 19

Forward flexion
extension
lateral extension

Question 20

Landmarks

• The tops of the iliac crest lie at the level of the
______interspace (or the L4 spinous process).
• The PSISs lie opposite ____

Answer 20

L3–4

S2.

Question 21

If lateral deviation (scoliosis) is present it

is usually _______

Answer 21

away from the painful side.

Question 22

What test?

The
patient lies supine with both knees extended and the
ankle dorsiflexed. The affected leg is raised slowly,
keeping the knee extended

Answer 22

SLR

Question 23

What is the SLR if there is sciatica

Answer 23

If sciatica with dural
irritation is present, 20 ° to 60 ° of elevation causes
reproduction of pain.

Question 24

The ________ is an excellent provocation test for
lumbosacral pain and is more sensitive than the SLR
test. It is a screening test for a disc lesion and dural
tethering

Answer 24

slump test

Question 25

When to do slump test?

Answer 25

It should be performed on patients who have low back pain with pain extending into the leg, and especially for posterior thigh pain.

Question 26

Positive slump test?

Answer 26

A positive result is reproduction of the patient’s pain, and may appear at an early stage of the test (when it is ceased).

Question 27

Significance of the slump test • If positive, it suggests ______. • If negative, it may indicate lack of serious disc pathology. • If positive, one should approach ____

Answer 27

disc disruption manual therapy with caution

Question 28

The neurological examination consists of: 1 quick tests: _____ 2 dural stretch tests: _____ 3 specific nerve root tests (L4, L5, S1): ____

Answer 28

walking on heels (L5), walking on toes (S1) slump test, straight leg raising sensation, power, reflexes

Question 29

What nerve roots? ``` • femoral stretch test (prone, flex knee, extend hip) • motor—extension of knee • sensation—anterior thigh • reflex—knee jerk (L3, L4) ```

Answer 29

L3

Question 30

What nerve roots? * motor—resisted inversion foot * sensation—inner border of foot to great toe * reflex—knee

Answer 30

L4

Question 31

What nerve roots? • motor: walking on heels, resisted extension great toe • sensation—middle three toes (dorsum) • reflex—nil

Answer 31

L5

Question 32

What nerve roots? * motor: walking on toes, resisted eversion foot * sensation—little toe, most of sole * reflex—ankle jerk (S1, S2)

Answer 32

S1

Question 33

``` Investigations for back pain can be classified into three broad groups: 1 2 3 ```

Answer 33

front-line screening tests; specific disease investigations; and procedural and preprocedural tests

Question 34

Continuous pain (day and night) = _____

Answer 34

neoplasia, especially malignancy or infection

Question 35

The other three metastases are from

Answer 35

thyroid, | kidney/adrenal and melanoma

Question 36

Pain with standing/walking (relief with sitting) | =______

Answer 36

spondylolisthesis

Question 37

In a young person with inflammation think of | _____

Answer 37

ankylosing spondylitis

Question 38

Stiffness at rest, pain with or after activity, relief | with rest =______

Answer 38

osteoarthritis

Question 39

Pain provoked by activity, relief with | rest = _______

Answer 39

mechanical dysfunction

Question 40

T or F The rule of thumb for the lumbar nerve root lesions is L3 from L2–3 disc, L4 from L3–4, L5 from L4–5 and S1 from L5–S1.

Answer 40

T

Question 41

A ___________ from anticoagulation therapy can give intense nerve root symptoms and signs

Answer 41

retroperitoneal bleed f

Question 42

Back pain in children Tumours causing back pain include ____ and ____

Answer 42

the benign osteoid osteoma and the malignant osteogenic sarcoma

Question 43

______ is a very small tumour with a radiolucent nucleus that is sharply demarcated from the surrounding area of sclerotic bone. Although more common in the long bones of the leg, it can occur in the spine

Answer 43

Osteoid osteoma

Question 44

``` Spondylolisthesis can occur in older children, usually due to a 1 2 3 ```

Answer 44

slip of L5 or S1, because the articular facets are congenitally absent or because of a stress fracture in the pars interarticularis

Question 45

_______ is still the most | common cause of back pain in the elderly

Answer 45

Traumatic spinal dysfunction

Question 46

The two nerve roots that account for most of these problems are L5 and S1 and the commonest disc lesion is _____closely followed by L5–S1.

Answer 46

L4–5,

Question 47

The pain is caused by extreme stretching of the interspinous ligaments or of the nerve roots. The onset of back pain in many of these patients is due to concurrent disc degeneration rather than a mechanical problem

Answer 47

Spondylolisthesis

Question 48

What should be avoided Spondylolisthesis?

Answer 48

hyperextension.

Question 49

_______ also known as degenerative osteoarthritis or osteoarthrosis, is a common problem of wear and tear that may follow vertebral dysfunction, especially after severe disc disruption and degeneration

Answer 49

Lumbar spondylosis,

Question 50

Lumbar spondylosis Cx

Answer 50

leading to subluxation of the facet joints spinal canal stenosis

Question 51

The ______ are a group of disorders characterised by involvement of the sacroiliac joints with an ascending spondylitis and extraspinal manifestations, such as oligoarthritis and enthesopathies

Answer 51

seronegative spondyloarthropathies

Question 52

Tests for non-organic back pain (the ‘migratory pointing’ test

Answer 52

Magnuson method

Question 53

How to do Magnuson method

Answer 53

1 Request the patient to point to the painful sites 2. Palpate these areas of tenderness on two occasions separated by an interval of several minutes, and compare the sites

Question 54

Tests for non-organic back pain What test? 1. Ask the patient to kneel on a low stool, lean over and try to touch the floor. 2 The person with non-organic back pain will usually refuse on the grounds that it would cause great pain or that he or she might overbalance in the attempt

Answer 54

Burn’s ‘kneeling on a stool’ test

Question 55

This may be effective for relatively isolated points using 5–8 mL of local anaesthetic. Studies indicate that it is likely to be more beneficial for chronic back pain

Answer 55

Trigger point injection

Question 56

This enzyme has been advocated for the treatment | of acute nuclear herniation that is still intact

Answer 56

Chymopapain

Question 57

Corticosteroid injection under radio-image intensification is widely used in some clinics. The procedure is delicate and expertise is required

Answer 57

Facet joint injection

Question 58

Physical therapy ______ are the best form of physical therapy

Answer 58

Active exercises

Question 59

Physical therapy _____ at the end range is a safe, effective method

Answer 59

Passive spinal stretching

Question 60

Physical therapy ________ is a gentle, repetitive, rhythmic movement within the range of movement of the joint

Answer 60

Spinal mobilisation

Question 61

_______ is a high velocity thrust at the end range of the joint. It is generally more effective and produces a faster response but requires accurate diagnosis and greater skill

Answer 61

Spinal manipulation