Flashcards in Rheum - Low Back Pain Deck (19):
Cauda equina syndrome - Symptoms? Cause? Treatment?
1. Lower back pain
2. saddle esthesia
3. bowel/bladder dysfunction
4. lower Extremity weakness
5. loss of reflexes.
Caused by compression multiple sacral nerve roots. Surgical emergency
Pain in the distribution of lumbar sacral nerve roots, with or without motor/sensory deficits
Anterior displacement of the upper vertebral body on the lower body – causes symptoms of spinal stenosis
Caused by spondylolysis or from degenerative disk disease
Sciatica can because by herniation what disks?
L4-L5 or L5-S1 level
A true radiculopathy radiates where?
Below the knee
Red flag symptoms in patients with low back pain?
1. Fever, unintentional weight loss, history of cancer, nighttime pain, pain that is worse in supine position (Cancer)
2. Major, motor weakness
3. Bowel or bladder incontinence, Saddle paresthesia
Primary cancers which metastasize to spine?
Lung, breast, prostate, lymphoma, G.I., melanoma
Patient with red flag symptoms or signs – workup?
If no red flags?
MRI should be reserved for patients for whom surgery is being considered.
If patient has no red flags start on nonnarcotic analgesic
Test for radicular pain?
1. Straight leg raise testing (however, not very sensitive or specific)
2. Patrick maneuver (Patient lies with his ankle over opposite knee while examiner presses down on the knee)
In treating idiopathic back pain, one should encourage the patient to?
Perform usual activity (superior to bed rest)
Bedrest is only appropriate for?
Patients without severe pain or neurologic deficits
Natural history of disc herniation with radiculopathy?
Resolve spontaneously within 4 to 6 weeks
Treatment for lumbosacral sprain?
1. NSAIDs on a fixed schedule
3. Muscle relaxants
Surgery referral for lower back pain if?
Does not resolve within 4 to 6 weeks
Most likely diagnosis (and treatment) if patient presents with back pain and:
1. Cancer history
2. High ESR and fever
3. Erectile dysfunction
1. Cord compression - STEROIDS first, then surgery
2. Epidural abscess - vanc and culture
3. Cauda equina - surgery
Only image pts if present with back pain and?
Focal neurological findings
Typical patient for lumbar spine stenosis?
#Worse with walking downhill
#Pain radiates to bilateral butt/thighs
#pulses and ABI normal
#less pain when leaning forward
Test for Lumbar spinal stenosis? Treatment?
#Weight-loss and pain meds
#then PT and steroids
# then surgery