Lower back pain and sciatica Flashcards Preview

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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

Typical causes of back pain in those >50yrs?

Degenerative disc
Osteoporosis
Paget's
Malignant
Myeloma
Lumbar artery atheroma