LSP DDX Flashcards
(15 cards)
Non-specific LBP (95%)
Discogenic
Arthrogenic
Flexion based
Extension based
(SIJ/ Hip/ Other)
Anatomy
Anterior/Ventral nerve roots: contain all motor nerves (myotomal)
Posterior / Dorsal nerve roots: contain all sensory nerves (dermatomal)
Dorsal root ganglion: processes messages from the spinal nerve before it reaches spinal cord
Motor and sensory nerve join to form spinal nerve, this then creates peripheral nerves in conjunction with other spinal nerves.
Radicular/Radiculopathy = Root
Radicular/neuro symptoms (5%)
Radicular pain
Radiculopathy
Myelopathy / stenosis
Neuro but not spinal
Radicular pain
Gain in nerve function caused by pathology at the nerve root / spinal nerve
More of a signal going through
Sharp, shooting, lancinating, burning
+Ve neurodynamic tests
However, Somatic / referred pain is much more common than radicular pain
Radiculopathy
Prevents normal conduction along nerve
Loss of function caused by pathology at the nerve root / spinal nerve
Look and listen for changes in myotomes, dermatomes and reflexes
Suggested -Ve neurodynamic tests = Slump, SLR
Worse when coughing or sneezing
Disc herniation, facet joint irritation, degenerative changes
Radicular pain and radiculopathy can occur at the same time
Somatic pain
Back pain that’s worse than leg pain
More likely to occur in proximal leg than distal
More of a diffuse pain
Less likely to have positive neurodynamic tests
Not expecting any myotomal, dermatomal or reflex changes
Myelopathy
M = Middle
Central compression of the spinal cord
Most common form is stenosis
Bi symptoms
Levels below also affected
Lumbar stenosis
Crowding around spinal tissue – compression of neurovascular structures – reduced nerve conduction
Thickening of ligamentum flavum
Foraminal narrowing
Bulging IV disc
Gradual onset
Age related condition as most associated with degeneration
Patients over 48
Affects 45-60% of older adults >65yrs
Worse with extension – compresses neurological structures
Worse with walking, better with flexion – shopping cart sign
Pain, cramping or weakness
Eased when sitting or leaning forward
Neuro but not spinal
Deep gluteal syndrome
Peripheral nerve
Upper motor neuron lesion
Degenerative cervical myelopathy
Diabetic neuropathy
B12 deficiency
Vascular PAD
Sinister pathology (<1%)
Fracture
Cancer / MSCC
Cauda equina
AxSpa
Discitis / Infection
Fracture
Significant trauma with pain after
More commonly osteopathic link
Women over 50
Sneezing, coughing, fall with or without soft landing, bending down sharply
Pain not improving
Worse at night
Constant and unremitting
Steroid use, smoking, poor nutrition, lack of sleep
CES
Nerve roots at bottom of spinal cord begins at L2
Skin around saddle, bowl, bladder, sexual function
Most common central disc herniation
Then MSCC
Progressive neurological worsening
A&E with warning card
Cancer
Strange location of pain – thoracic, ribs, abdominal
Night pain, can’t sleep for hours or any position, sleep in a chair
Worsening, Past medical Hx
Could develop neuro symptoms
Weight loss is a late sign
MSCC
Tumour compresses spinal cord
Bi neuro
Progressive neuro
Most likely to metastasise:
Prostate
Breast
Lung
Thyroid
Kidney
AxSPA
Fusion of joints around spine and SIJ
Most common complaint is spinal pain and stiffness followed by fatigue
Onset 20-40
Male 3.5:1 female
Early morning stiffness more than 45mins
Pain at night (2nd half)
Family Hx of Rheumatological conditions
Common link with IBS – diahoria cramping
