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MSK > Back Pain > Flashcards

Back Pain Flashcards

1
Q

What are the differen types of back pain?

A 
Viscerogenic (abdomen)
Spondylogenic (joints and muscles)
Discogenic (IV disc)
Neurogenic (nerve root)
Psychoenic
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2
Q

What can cause viscerogenic pain?

A 
Peptic ulcer disease
Gallbladder 
Pancreas
Renal
Uterine/ ovarian
Colonic
AAA
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3
Q

What needs to be assessed in back pain?

A

SOCRATES

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4
Q

What type of pain is nerve root leg pain?

A 
SCIATICA
Dermatomal
Sharp, shooting pain 
Goes below the knee to the foot and ankle 
Anatomical sensory/motor symptoms
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5
Q

What type of leg pain does referred leg pain from facet joints cause?

A 
Non specific 
Dull pain
Common in buttocks and thigh
Never below knee 
Ill-defined sensory symptoms
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6
Q

What neurological symptoms will back pain cause?

A 
Bowel and urinary incontinence
Bilateral or unilateral leg symptoms
Paraesthesia
Numbness
Weakness
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7
Q

What features are red flags in back pain?

A 
Non-mechanical pain
Thoracic pain
PH - carcionoma, steroids, HIV
Systemic upset
Major, new neurological deficit
Saddle anaesthesia +/- bladder or bowel upset
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8
Q

What spinal pathologies can cause back pain?

A

OA can cause wedge fractures
Tumours - primary myeloma or mets
Infection - destruction of vertebrae and pus
Ankylosing spondylitis

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9
Q

What cancers commonly metastasise to the spine?

A

Bad Boys Pee Through Kidneys

Breast, Bronchus, Prostate, Thyroid, Kidney

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10
Q

What are the different types of disc prolapse?

A

Prolapsed (still contained within the posterior ligament)
Extruded
Sequestrated

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11
Q

How can large vertebral canal cause back pain?

A

Stretched annulus/ posteiror long ligament

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12
Q

How can small vertebral canals cause back pain?

A

Root compression causes release of inflammatory mediators

Root pain and tension signs

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13
Q

Where will sacroiliac joint pain refer to?

A

Buttock, back of thighs and facet joints in spine

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14
Q

What is spondylolisthesis?

A

Spondylolisthesis is a slipping of vertebra that occurs, in most cases, at the base of the spine

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15
Q

What is spondylolysis?

A

Defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5)

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16
Q

What should be examined in a back pain exam?

A 
Observation
Range of movement
Neruological assessment
Nerve root irritation
Distraction testing
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17
Q

What nerves allow for hip flexion?

A

L1/2

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18
Q

What nerves allow for knee extenion?

A

L3/4

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19
Q

What nerves allow for foot dorsiflexion?

A

L5

20
Q

What nerves allow for ankle plantarflexion?

A

S1/2

21
Q

What are the 2 nerve irritaion tests?

A

Sciatic stretch test

Femoral nerve test

22
Q

What specialised investigations are used for back pain?

A 
MRI - BUT BEWARE
Diagnostic facet injection
Contrast CT
Provocation discography 
Selective nerve block
23
Q

What is sciatica?

A

Buttock or leg pain in a specific dermatomal distribution accomapined by neurological distribution

24
Q

What is the common presentations of disc prolapse?

A

Episodic back pain
Onset of leg pain
Myotomes and dermatomes

25
Q

How is backache treated?

A

Short bed rest
Anti-inflammatory +/- muscle relaxant
Mobilise thereafter
Physical therapy

26
Q

What are red flag symptoms point to cauda equina syndrome?

A

Dysfunction of baldder, bowel or sexual function

Sensory changes in saddle or perianal area

27
Q

What reg flag symptoms point to discitis/ infection?

A

Sudden onset of acute spinal pain or suspicioud change in pattern, no history of trauma
Systemic signs; fever, high pulse
Night pain
All spinal movements grossly restricted by pain and spasm

28
Q

What red flag symptoms point to an inflammatory spondyloarthropathy?

A

Morning stiffness and backache or multiple joint problems
Generally inwell
Associated skin rash, IBD, eye problems, urethritis, SIJ pain

29
Q

What conditions should be referred to a spinal specialist?

A

Lumbar disc prolapse with uncomplicatied sciatica
Lumbar spinal stenosis
Mechanical back pain

30
Q

What spinal conditions are emergencies?

A

Cauda equina syndrome

Fracture with deteriorating neurology

31
Q

What should the x-ray show for a C spine?

A

Make sure shows C7/T1

32
Q

Where are the most common thoracolumber injuries?

A

T12 or L1

33
Q

In what ways can the spinal cord be involved in a pathology?

A

Size of spinal canal
Location of injury
Bone pinching
Contact pressure

34
Q

What can cause a secondary cord damage?

A 
Cord swelling
Oedema
Ischaemia
Thrombosis of small vessels
Venous obstruction
35
Q

What is a complete cord injury?

A

Complete severing of spinal cord

36
Q

What will cause a central cord injury?

A

Typical hyperextension injury
Arms worse than legs
Prognosis variable

37
Q

What are the symptoms of a brown sequard injury?

A

Paralysis on ipsilateral side

Hypaesthesia on contralateral side

38
Q

What symptoms will an anterior cord injury cause?

A

Motor loss
Loss of pain and temp sense
Deep touch, position and vibration preserves

39
Q

What deformities can scoliosis cause?

A

Rotational component
Lateral bend component
Rib deformaties
Visceral abnormalities

40
Q

What are the different types of scoliosis?

A

Congenital
Early onset idiopathic
Late onset idiopathic
Secondary

41
Q

What causes a congenital scoliosis?

A

Imbalance in the number of growth plates and the greater the imbalance the worse the deformity

42
Q

What is heuter-volkmann’s law?

A

Increased pressure across an epiphyseal plate inhibits growth

43
Q

What can produce a secondary scoliosis?

A

Neuromuscular
Tumours
Spina Bifida

44
Q

What are the non-operative managments of scoliosis?

A

Serial corrective casts
Bracing
Corrective exercises
Electrical simulation

45
Q

What is kyphoysis?

A

Centre of gravity anterior to spine

Opposite of scoliosis

46
Q

What are the yellow flags for chronic back pain?

A 
Low mood
High levels of pain
Belief that activity is harmful 
Low educational level
Obesity 
Problem with compensation
Job dissatisfaction
Light duties not avaliable at work
Lots of lifting at work

MSK (34 decks)

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