Flashcards in Lower back pain and sciatica Deck (51):
1
What defines acute lower back pain?
Anything less than 6 weeks
2
What should be evaluated in someone with LBP?
Determine is pain is intrinsic and not referred from elsewhere; AAA
Rule out life threatening disease; in children screen for cancer
Determine whether root compression is present
3
General red flags in back pain?
Failure to improve after 4-6 weeks
Unrelenting night pain or pain at rest
Progressive motor or sensory deficit
4
Cancer red flags
Age >50
Unintended wt loss
Hx of ca
Pain at night and in recumbency
5
Infection red flags
Fever/chills
Recent infection
Immunosuppression
IVDU
Dental status; 60-70% of brain and spinal abscesses have a dental origin
Foreign travel
6
RF for #
Age >50
Osteoporosis
Significant trauma
Chronic steroid use
7
Sy for CES
Bilateral sciatica
Urinary incontinence
Leg weakness
Absent anal tone
Loss of perianal sensation; most sensitive indicator
8
Sy of AAA
Age >60
Male
Abdo pulsating mass
Pain at rest
9
LL neurological exam
SLR
Muscle strength
Sensation; light touch, pin prick, vibration
Deep tendon reflexes
10
Nerve root for flexion of hip
L2,3
11
Nerve root for extension of hip
L4,5
12
Nerve root for extension of knee
L3,4
13
Nerve root for flexion of knee
L5,S1
14
Nerve root fo plantarflexion
S1,2
15
Nerve root for dorsiflexion
L4,5
16
Nerve root for eversion
L4
17
Nerve root for inversion
L5,S1
18
Nerve root for shoulder abduction
C5
19
Nerve root for shoulder adduction
C6,7
20
Nerve root for elbow flexion
C5,6
21
Nerve root for elbow extension
C7,8
22
Nerve root for wrist flexion and extension
C6,7
23
Nerve root for finger abduction
C8,T1
24
Nerve root for finger flexion
C7,8
25
Nerve root for finger extension
C7,8
26
Nerve root for supination
C6
27
Nerve root for pronation
C7,8
28
When should you request an x-ray in LBP?
Young men; SI-joints to exclude ank spon
Elderly; exclude vertebral collapse, # or malignancy
29
What is a CT good for in terms of localisation of pathology of the spine?
Bony pathology; trauma, tumour, infection
Foreign bodies
Implants
Spinal fusion planning
30
What is an MRI good for in terms of localisation of spinal pathology?
Soft tissue; tumours, infection
Bone oedema
Can see spinal cord MUCH better
31
What modality of imagine should be used for spinal pathologies that have red flags or neurological si/sy?
MRI
32
What will radionucleotide scans show?
Increased bone turnover; #, osteomyelitis, paget's, ank spon
Mets
Tumours; osteoid osteoma
33
When should lab tests be utilised in LBP?
Malignancy; PSA, acid phosphate, monoclonal bands
Infection
Metabolic; alk phos, calcium, phosphate, HLA B-27
34
When should LBP be investigated?
No improvement after 4-6 weeks
Red flags
35
When should LBP be referred to secondary care?
Intractable pain
Serious pathology suspected or suggested initial imaging
Neurological deficit
36
What are risk factors for back pain?
Previous back pain
Heavy lifting/ frequent bending
Repetitive work with exposure to vibration
37
What is the most effective preventative measure for back pain?
Exercise
38
What are differential diagnosis for sciatica?
Root compression by other degenerative disease: bony spurs, canal stenosis, spondylolisthesis, facet hypertrophy
Root compression of sinister cause: tumour, fracture, TB
Root compression from outwith the spine: piriformis syndrome, endometriosis, pelvic disease, peroneal compression (painless foot drop)
No root compression: arachnoiditis, peripheral neuropathy
39
What commonly causes an increase in pain with a disc prolapse?
Coughing
Sneezing
Twisting
40
What are the examination signs of a L5/S1 disc prolapse?
Reduced forward flexion and extension (all disc prolapses)
Calf pain
Weak foot plantar flexion
Reduced pin prick over sole of foot and back of cald
Reduced ankle jerk
41
Examination findings in an L4/L5 disc prolapse
Hallux extension weak
Reduced sensation on outer dorsum of foot
42
What causes CES?
Central prolapse of lumbar disc
43
When is a discectomy indicated?
CES
Progressive muscular weakness
Continuing pain
44
What is spondylolisthesis?
Displacement of one lumbar vertebrae on another usually L5 on S1
45
What can cause spondylothesis?
Spondylosis (age related degeneration with osteophyte formation)
Congenital malformation
OA of facet joints
46
What causes lumbar spinal stenosis and lateral recess stenosis?
Generalised narrowing of lumbar spinal canal or its lateral recesses causing nerve ischaemia
Facet joint OA and osteophytes
47
What are the symptoms of spinal stenosis and lateral recess stenosis?
Pain worse on walking
Pain on extension
Negative SLR
Few CNS signs
48
Yellow flags for back pain
Belief that pian and subsequent activity are harmeful
Pain behaviour
Over-reliance on passive treatments
Depression, anxiety, personality disorders
Unsupportive home environment or over-protective family
Inappropriate expectations and failing to actively engage with tx
49
Typical causes of back pain in those 15-30yrs?
Prolapsed disc
Trauma
#
Ank spon
Spondylolisthesis
Pregnancy
50
Typical causes of back pain in those >30yrs?
Prolapsed disc
Malignancy (lung, breast, prostate, thyroid kidney)
51