Back Pain and Sciatica Flashcards Preview

Neurology > Back Pain and Sciatica > Flashcards

Flashcards in Back Pain and Sciatica Deck (32):
1

what is buttock pain likely to be

muscular

2

what is back pain going to below the knee likely to be

nerve- disc problem

3

what are the general red flags for back pain

general
- failure to improve after 4-6 of conservative treatment
- unrelenting night pain or pain at rest
- progressive motor or sensory deficit

4

what are the cancer red flags in back pain

cancer
- age > 50
- unintentional weight loss
- Hx of cancer
- pain at night and in recumbency

5

what are the infection back pain red flags

infection
- fever/ chills
- recent infection
- immunosuppression
- IV drug use
- dental status
- foreign travel

6

what are the cauda equina red flags

- Bilateral sciatica
- Urinary incontinence
- Leg weakness
- Absent anal tone
- Loss of perianal sensation

7

what are the red flags for fracture in back pain

- age > 50
- osteoporosis
- significant trauma
- chronic steroid use

8

what are the res flags for AAA in back pain

- age > 60
- abdominal pulsating mass
- pain at rest

9

what root levels:
hip flexion

L2,3

10

what root levels:
hip extension

L4,5

11

what root levels:
knee extension

L3,4

12

what root levels:
Knee flexion

L5,S1

13

what root levels:
ankle dorsiflexion

L4,5

14

what root levels:
ankle plantarflexion

S1,2

15

what root levels:
foot eversion

L5,S1

16

what root levels:
foot inversion

L4

17

what are the MRC muscle power grades

0- complete paralysis
1- flicker of contraction possible
2- movement possible if gravity eliminated
3- movement against gravity but not resistance
4- movement possible against some resistance
5- power normal

18

do you need to investigate all back pain

no 70-90% are innocent, resolve in a month with conservative Tx

19

when should you do an x ray

do not x ray routinely
except in
- young men at SI joint to exclude ank spon
- elderly to exclude vertebral fractures, collapse, malignancy
-for deformity correction surgeries

20

what are CT scans good for

bony pathology- trauma, tumours, infection)
-good for foreign bodies, implants
-spinal fusion planning
-if MRI contraindicated/ not available
-limited use in acute LBP unless red flags

21

what is MRI good for

red flags in back pain= MRI
neurological signs/ symptoms= MRI

- soft tissue (inc tumours and infection)
- some sequences good for new fractures
- bone oedema/ microfractures

22

what do radionucleotide scans show

increased bone turnover (tumours, pagets, fractures, osteomyelitis, ank spon, mets, osteoid osteoma)

23

what does a PET scan show

increased uptake in high turnover areas

24

when do you do lab tests in back pain

when red flags present
- malignancy (PSA, acid phosphate, monoclonal bands)
-infection
-metabolic causes (alk phos, Ca2+ etc)

25

what is the treatment for back pain

aim to relieve pain and find underlying cause
-explanation, reassurance, advice on activity and exercise, NO BED REST
-WHO pain ladder
- facet joint/ epidural injections for pain relief
-complementary and alternative mechanisms (acupuncture, chiropracture, osteopath, massages, PHYSIOTHERAPISTS)

26

what do you investigate back pain

no improvement in 4-6 weeks
any red flags

27

when do you refer back pain

-intractable pain
-serious pathology suspected or suggested on initial imaging
-neurological deficit

28

what are the risk factors for mechanical back pain

previous back pain
heavy lifting/ frequent bending
repetitive work with exposure to vibration

29

how do you prevent mechanical back pain

education- lifting, turning etc, mental coping strategies, stopping smoking
maintain physical activity

30

what are the differential for causes of sciatic back

-root compression by degenerative causes (bone spurs, canal stenosis, spondylolisthesis, facet arthropathy)
-root compression of sinister causes (tumour, fractures, TB)
-root compression of sinister causes (tumour, #, TB)
-root compression outside the spine (piriformis syndrome, endometriosis, pelvic disease, peroneal compression)
-no root compression (arachnoiditis, peripheral neuropathies)

31

what is piriformis syndrome

when the sciatic nerve goes through the piriformis muscle which can compress the nerve

32

is sciatic permanent

no generally self limiting