Low Back Pain Flashcards
(36 cards)
What does lower back pain radiation to the buttocks mean>
- muscle pain
What does lower back pain to the knees mean>
possible slip disc
What associated symptoms should you ask for, if pc is Lower back pain?
- stiffness of back
- numbness/ tingling
- urinary symptoms
What non-pharmacological measures can be taken for lower back pain?
- massage
- chiropactor
- osteopath
- acupuncture
- PT
Name major/ dangerous ddx for lower back pain.
- CANCER
- INFECTION
- #
- Other general things
- CES
- AAA (abdominal aortic aneurysm)
What things should be considered to mark lower back pain as a definite concern?
- failure to improve after 4-6 weeks of conservative therapy
- UNRELENTING night pain/ at rest
- progressive motor/ sensory deficit
When is cancer a considered a red flag in a pt?
- if pt is >50 y.o
- had unintended weight loss
- hx of CANCER
- pain at NIGHT and when lying
When is infection of the spine considered a red flag?
- fever/chills
- recent infection
- IMMUNOSUPPRESSION
- iv drug use
- poor DENTAL status
- foreign travel
When to suspect Cauda-Equina syndrome,as a red flag?
- bilateral sciatica
- urinary incontinence
- leg weakness
- decr. ANAL tone
- loss of perianal sensation
When is a fracture of a spine esp. considered as a red flag?
- IF pt is >50y.o
- has osteoporosis
- hx of signif. trauma
- chronic STEROID use
Why may AAA cause lower back?
- the aneurysm becomes so big, it may just erode the vertebra
When to suspect AAA as a red flag?
- age >60y.o
- presence of an abdominal pulsating MASS
- pain at REST
- cardiac syncope more than pain
- pain could be at abdominal/ flank/ groin
What special tests at the bedside that could be performed for lower back pain?
- Straight leg raise
- muscle strength
- sensation
- deep tendon reflex
What does SLR test?
- the test stretches the sciatic nerve and the hamstrings
- pain radiate to the lower extremity with compression of the saccral nerve roots
- —sign of disc herniation
Patient comes in with pain running straight down the leg from the mid-butt. She is unable to walk on her toes. What nerve root is involved?
- weakness on plantar flexion of great toe and foot, suggests ..
- S1 nerve root compression
Pt is has pain shooting down the lateral aspect of her right leg (starting at the lower back).
- he is unable to walk on his HEELs. What nerve root is involved?
- L5
- –INABILITY TO dorsiflex great toe and foot
Pt comes in complaining of pain shooting down the lateral thigh and shifting to the medial aspect of the calf. There is diminished knee reflex.. What nerve root is involved, and which muscle is affected?
State another screening test in this nerve root compression.
- nerve root L4 is compressed
- weakness of the Quadriceps
- screening test for L4= SQUAT and RISE
What nerves are tested in the biceps reflex?
C5 and C6
What nerve roots are tested with the triceps reflex?
C7 and C8
What nerve roots are tested with the patellar reflex?
L2,L3 and L4
What nerve root is tested with the achilles reflex?
S 1
Do pts with acute onset Lower back pain need investigating?
NO
70-90% of LBP WILL resolve within a month
What invx to be performed if LBP has not resolved?
- CT
- MRI
- XRay
- BONE SCAN
- PET/SPECT
What labs to be performed with chronic LBP?
- FBC
- U&Es
- inflammatory markers
- check for metabolic causes (Ca2+, PO4, HLA B-27, alk phos.)
- malignancy (PSA, acid phosphatase, monoclonal bands)
