STEP 2: LBP

Question 1

The combination of low back pain radiating into both legs, exacerbated by standing/walking, and relieved by sitting/lying down, is the hallmark symptom complex known as___________________

Answer 1

neurogenic claudication.

Question 2

“shopping cart sign” (relief with leaning forward) is pathognomonic for

Answer 2

neurogenic claudication.

Question 3

Diminished peripheral pulses are a sign of what kind of claudication?

Answer 3

Check peripheral pulses. Diminished pulses are the hallmark of vascular claudication.

Question 4

Unilateral or bilateral:

neurogenic claudication

Answer 4

bilateral

Question 5

Unilateral or bilateral:

sciatica

Answer 5

unilateral

Question 6

How do the neurologic findings differ between sciatica and neurogenic claudication?

Answer 6

Sciatica often has clear focal neurological deficits (dermatomal/myotomal), whereas neurogenic claudication might have more diffuse or absent focal findings

Question 7

What is the classic symptom complex of Neurogenic Claudication?

Answer 7

Pain/discomfort in both legs, triggered by standing or walking, relieved by sitting or bending forward.

Question 8

What is the classic symptom complex of Vascular Claudication?

Answer 8

Cramping, aching, or tightness in muscles, triggered by walking/exercise, relieved by standing still/rest.

Question 9

How do Neurogenic Claudication and Vascular Claudication differ in terms of relief and pulses?

Answer 9

Neurogenic Claudication: Relieved by sitting or bending forward. Normal peripheral pulses.
Vascular Claudication: Relieved by standing still/rest. Diminished or absent peripheral pulses.

Question 10

What are the key features of Sciatica (Lumbar Radiculopathy)?

Answer 10

Unilateral sharp, shooting pain radiating down the leg, often caused by nerve root compression, may have sensory loss or muscle weakness.

Question 11

Name at least 3 neurological ‘red flags’ for back pain.

Answer 11

• Bowel or Bladder Dysfunction
• Saddle Anesthesia
• Progressive or Severe Neurological Deficit

Question 12

What constitutional symptoms or systemic illness factors are ‘red flags’ for back pain?

Answer 12

• Unexplained Weight Loss
• Fever, Chills, Night Sweats
• History of Cancer
• Immunocompromised state

Question 13

What pain characteristics are considered ‘red flags’ for back pain?

Answer 13

• Constant, Severe, and Progressive Pain
• Night Pain
• Thoracic pain
• Pain unchanged by rest or postural modification

Question 14

What age-related or trauma-related factors are ‘red flags’ for back pain?

Answer 14

• Age of onset < 20 years or > 50-55 years
• History of Significant Trauma
• Minor Trauma in Older Adults

Question 15

Underlying Cause

Neurogenic Claudication (NC)

Answer 15

Spinal Stenosis (narrowing of the spinal canal, compressing nerve roots, usually degenerative)

Question 16

Underlying Cause

Vascular Claudication (VC)

Answer 16

Peripheral Artery Disease (PAD) (atherosclerosis leading to reduced blood flow to muscles)

Question 17

Underlying Cause

Sciatica (Lumbar Radiculopathy)

Answer 17

Nerve Root Compression (e.g., herniated disc, bone spur, tumor) of the sciatic nerve roots (L4-S3)

Question 18

Neurogenic, vascular, or sciatica:

triggered by sitting, coughing, sneezing, straining, prolonged standing/sitting in certain positions.

Answer 18

Sciatica (Lumbar Radiculopathy)

Question 19

What diagnostics do we do for neurogenic claudication?

Answer 19

MRI Lumbar

Question 20

What diagnostic tests do we do for sciatica?

Answer 20

MRI of Lumbar Spine (often after failed conservative therapy).

Question 21

What diagnostic tests do we do for vascular claudication?

Answer 21

ABI!!