What is the mnemonic for the ddx for neck and back pain ?
I MDT Inflammatory Infective Mechanical pain Degenerative Trauma
What is the differentials for Neck Pain ? 😭
Inflammatory: ankylosing Spondylosis Infective: Discitis Mechanical neck pain Degenerative: Cervical spondylosis/myelopathy/Radiculopathy + Malignancy Trauma: Whiplash and Cervical Fracture
What is the differentials for Back Pain ? 😭
Inflammatory: Ak + seronegative spondylopathies
Mechanical Back pain
Degenerative: Cauda Equina and Malignancy: (bone mets + myeloma)
Trauma: osteoporotic crush fracture, Paget’s disease and Hyperparathyroidism
What are the other causes of BacK pain with regards to the Ff:
- non-spinal causes (3)
- neurological causes (4)? 😭
- Non spinal and serious causes (3): AAA, dissecting Aortic aneurysm and pancreatitis
- Neurologacl causes (4): 3SL sciatica, spondylolysis , spondylolisthesis and lumbar canal stenosis
What is the mnemonic for Red flags of Back pain ?
State the red flags of BACK PAIN 😭
Bladder/Bowel dysfunction + B symptoms (NWF, fatigue)
Age <20 or >55 years old
Constant or progressive back pain + nocturnal pain
Kick leg: Bilateral or alternating leg pain
Pain in the thoracic spine
A Hx of TB/HIV/Malignancy
Neourological: saddle anaesthesia
What is the history for Back pain and mnemonic for associated symptoms ?
O SOCRATES + 3PS
Associated symptoms: SSRLs
Describe the symptoms simple mechanical power back pain (4)
- Sudden/spontaneous onset of mild back pain
- Pain may be referred to buttocks/thigh
- Pain worse with movement and eased by rest
- . History of mild trauma/heavy lifting
What do you find on examination for mechanical Back pain (1) ?
Palpable muscle spasms leading to local tenderness
What is the treatment of simple mechanical Back pain ?
- Simple analgesia + keep active with normal physical activity
What is SCIATICA ?
Lumbar Radiculopathy which may occur due to acute lumbar disc prolapse peripherally or compression/entrapment of sciatic nerve)
What are the symptoms of sciatica ?
Lower back pain + unilateral leg pain/numbness radiating to below the knee to foot/toes (can be bilateral/rare)
-Triggering event known
What are the 2 examination findings ?
Femoral stretch test and Straight leg raise +ve
What is the management of Sciatica ?
NSAIDs (if Congress codeine)+ PPI monitoring of pain + physiotherapy with/without CBT
2nd Line: Referral to chronic pain specialist: Epidural injection
Surgery: Spinal decompression