Back Pain and Sciatica Flashcards Preview

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Flashcards in Back Pain and Sciatica Deck (32)
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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)