Flashcards in Prolapsed disc and mechanical backache Deck (25):
Why should you be wary of a patient who knows the exact date adn time his back pain started?
very unusual for back pain to start with one bad incident, usually creeps up suspiciously- patient may have secondary issues
What are the red flag symptoms in a back pain history?
major, new , neurological deficit
saddle anasthesia +/- bladder or bowel upset
What are the myotomes that control hip flexion?
What are the myotomes that control L3/4?
What are the myotomes that control foot dorsiflexion and EHL?
What myotomes control ankle plantarflexion?
What is the test to test plantar reflexes?
How useful are walking aids in back pain?
walking aids do not help back pain
What are examples of overt pain behaviour?
guarding; bracing; rubbing; grimacing; sighing
What are behaviourla responses seen with chronic pain?
tests which do not cause additional stress on the spine but patients respon to
What are examples of bevioural responses?
superficial/non-anatoical tenderness' simulation- axial loading/ roataion
over-reaction to exam
regional- sensory distubrance, giving way
/what is distraction SLR?
When a patient can sit up to 90 degrees with legs straight out but cant stright leg raise much
What is the gold standrard investigation with back pain?
What is sciatica?
buttock and/or leg pain in a specific dermatomal distribution accompanied by neurological disturbance
What is the common presentation of disc proleapse?
episodic back pain; onset of leg pain +/- neurology; leg pain becomes dominant
Why should surgery not be undertaken within 3 months of onset of symptoms of disc prolapse?
70% of cases will settle within 3 months
When is disc prolapse an emergency?
cauda equina syndrom
What is conservative management of backache?
short bes rest (debatable); anti-inflam +/- muscle relaxant; mobilise thereafter; physical therapies; return to normal activity
What is the aim for back pain management?
ideal is fast, active rehab; reassurance; rapid return to work
What is the problem with surgery in adjacent segment disease?
tends to just push the problem further up after fusion
What happens during chronic pain syndrome?
central pain perception is squeed
What are behavioural symptoms?
pain at tp of coccyx; whole leg pain/numbness/giving way; absnce of pain ree spells; intolerance of treatment; emergenc admission
What should you note in patinets who have behavioural symptoms?
typidcally wont respond to physical help- need to collaborate with MDT
What is the importance of a stress history?
there is increasing evidence of link between chronic pain and childhood abuse