Lower Back Pain Flashcards Preview

Skin MS: Week 4 > Lower Back Pain > Flashcards

Flashcards in Lower Back Pain Deck (24):
1

History taking for back pain

Character/location
onset
course
relationship to work/activity
exacerbating or relieving factors
prior tx
litigation/work comp

2

mechanical LBP

most common dx in adults
Frequently multifactorial

3

mechanical lbp common causes

Muscle spasm
facet joint inflammation
SI joint dysfunction

4

PE for LBP (mechanical)

Inspection, palpation, ROM, joint/muscle provocative tests, straight leg raises, neurologic testing

5

Evaluation for mechanical lbp

Xray**
MRI
CT
TPBS
EMG

6

mechanical lbp tx

TIME AND MOVEMENT
Early mobilization
physical therapy
core stabilization
adjustment/manipulation
massage (rolfing)

7

Mechanical LBP prognosis and recurrence

35% in 1 mo
85-90% in 3 mo
95% in 6 mo

62% recur in 1 yr
80% in 2 yr

* manage and prevent

8

Degenerative diseases

spinal stenosis
facet arthrosis
spondylolisthesis
sacroiliac arthrosis

9

DJD/SS pathophysiology

gradual narrowing of spinal canal and/or neural foramina
osteophyte formation, facet hypertrophy, bulging disks, hypertrophy of ligamentum flavum

10

DJD/SS Dx

low back pain radiating posteriorly to ankles and feet
symptoms worse w/ erect posture
numbness, tingling, foot drop
kip, knee, ankle, foot pain

11

DJD/SS tx

TIME AND MOVEMENT
PT
meds (steroids, NSAIDs, narcotics)
Dorsal column stimulators
surgery (MAJOR)

12

Spondylolisthesis

forward slipping of one vertebrae on another

13

Spondylolisthesis clinical presentation

frequently asymptomatic
may be painful (motion, sleeping)
radicular sxs w/ nerve root irritation

14

Spondy tx

non op - meds, PT, TENS
op only if progressive slip, uncontrolled pain

15

Acute disc herniation presentation

LBP
identifiable precipitant
radicular sxs (sciatica)
sensory sxs
motor sxs

16

Acute Disc herniation physical findings

Splinting (leaning)
+/- tenderness
straight leg raise
reflexes, motor function, sensory exam

17

Acute disc herniation tx

TIME AND MOVEMENT
active rest
oral steroids
pain meds
+/- PT
*not chiro
MOST GET BETTER W/OUT SURGERY

18

Acute disc herniation indications for surgery

pain, corresponding lesion on MRI, radicular sxs, motor weakness, surgical candidate

19

Acute disc herniation surgery

microdiscectomy
fusion

20

causes of sciatica

disc disease
spinal stenosis
piriformis entrapment
peripheral entrapment
vascular claudication
others

21

Back pain in children causes

mechanical (less common)
spondylolysis/spondylolisthesis
disc disease
tumor
infection
rheum
visceral
psychosomation

**Usually more serious and need to follow up

22

What to know about child back pain (hx)?

location, precipitants/modifiers, activity, radicular sxs, constitutional sxs, associated sxs, home stressors

23

Back pain in children - dx

Xrays - 5 view
TPBS ***
MRI
CT
+ lab work (less likely - CBC, CRP, ESR, rheum, LP, EMG)

24

spondylolysis tx in kid

activity modification
time
bones stimulator
bracing, surgery?