Flashcards in Bone Mets Deck (14):
Red flags for back pain
Loss of power in limbs (difficulty walking)
Loss of sensation in limbs and perineum
Lack of bladder or bowel control (including urinary retention)
Red flags for back pain in PMH
Previous Hx of malignancy
Epidemiological red flags for back pain
New onset back pain in children or older adults (>50)
Important question to assess nature of back pain
Is it worse at rest?
If so, red flag.
Back pain in what area is a red flag?
Thoracic back pain is red flag
Differentials for back pain
Cord compression (trauma, compression fracture, disk herniation, spinal tumour / met, infection)
Mechanical back pain
How do you investigate red flagged back pain?
What is metastatic spinal cord compression?
Compression of the spinal cord and/or cauda equina due to a metastatic cancer near the spinal cord.
Symptoms of spinal cord compression:
Weakness / paralysis
Bladder or bowel dysfunction
Examination findings in cord compression
Increase in tone
Loss of power
Hyper-reflexia (especially associated with malignancy)
Loss of sensation (pinprick, temperature, vibration, position)
Loss of tone (spinal shock)
Investigations for suspected cord compression
CT-guided biopsy and histopathology
Differentials for cord compression
Treatment for malignant spinal cord compression
Corticosteroids (relieve pain, reduce oedema)