Back pain Flashcards by Madeleine Hebert

General groups of causes of low back pain

non-specific mechanical low back pain
spinal stenosis
disc herniation with radiculopathy
infectious/inflammatory
vertebral body metastasis
referred/non-orthopedic causes

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Predisposing factors for mechanical low back pain

previous injury

- older age

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Categories of mechanical low back pain

muscle strain

- degenerative disease

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Discriminating features of mechanical low back pain

usually in lumbosacral area
generally does not radiate below knee
worse with activity and better with rest
generally does not wake pt. from sleep
acute, recurrent, or chronic

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Physical exam features of mechanical low back pain

many features may appear normal
tenderness or spasms over paraspinal muscles
kyphosis for osteoporotic fracture
range of motion may be decreased
radiologic findings normal unless spondylolysis

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Forms of degenerative disease in mechanical low back pain

disc herniation without root compression
spondylolisthesis
spondylolysis
osteoarthritis

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Spondylolysis

defect in vertebral arch causing separation from vertebral body

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Spondylolisthesis

vertebral body slides anteriorly over vertebral body below, may cause spinal cord compression
-common in pregnant women!

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Pathophysiologic insult of spinal stenosis

hypertrophic degeneration of ligaments or facets, causing narrowing of canal

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Predisposing factors for spinal stenosis

older age
congenital abnormalities (achondroplasia)
metabolic or endocrine disorders

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Discriminating features of spinal stenosis

usually chronic
usually lumbosacral area
common associated buttock or leg pain
pain worse with walking or standing, relieved with sitting

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Physical exam features of spinal stenosis

-nonspecific unless radiculopathy

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Pathophysiologic insult of disc herniation with radiculopathy

herniation of nucleus pulposus

- nerve root injury secondary to compression or inflammation

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Predisposing factors for disc herniation with radiculopathy

trauma or severe strain

- severe coughing or val salva maneuver

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Discriminating features of disc herniation with radiculopathy

acute or acute on chronic
usually lumbosacral area
pain radiates down leg below knee!
associated numbness, tingling, or weakness or dermatomal sensory loss
may cause bladder or bowel dysfunction
usually worse with movement and better with rest
usually worse with coughing, val salva, or sitting

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Physical exam features of disc herniation with radiculopathy

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tenderness over paraspinal muscles
range of motion may be decreased
neurologic signs correlating with root level!
motor weakness, loss of light touch sensation, decreased reflexes
MRI or CT show disease

Infectious/inflammatory conditions of lower back pain

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vertebral osteomyelitis
discitis
epidural or paraspinous abscess

Pathophysiologic insult of infectious/inflammatory causes of low back pain

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localized inflammation

- acute (Staph aureus) or chronic

Predisposing factors for infectious/inflammatory low back pain

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IV drug use

- history of recent/intermittent infection

Discriminating features of infectious/inflammatory low back pain

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acute, progressive, or chronic
can occur at any location
no relief with rest
often wakes patients from sleep!
systemic symptoms: fever, chills, fatigue
if chronic, weight loss and night sweats

Physical exam features of infectious/inflammatory low back pain

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fever
point tenderness on palpation
may have limited range of motion
typically normal neurologically
MRI typically shows infection
other indicative labs: high WBC, high ESR/CRP, or blood cultures

Predisposing factors for vertebral malignancy

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history of previous or current cancer

- family history of cancer

Pathophysiologic insult of vertebral malignancy

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metastasis of cancer from primary site

- infiltration of bone tissue by malignant cells

Discriminating features of vertebral malignancy

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acute or chronic
localized or diffuse
constant, dull
presence at night or wakes patient from sleep!
no relief with rest
systemic symptoms: weight loss, night sweats, fever
variable neurologic symptoms, present if mass effect

Physical exam features of vertebral malignancy

- may be ill-appearing - point tenderness on palpation - may have limited range of motion - neurologic symptoms if mass effect - MRI may show metastases in vertebral bodies

Types of referred/non-orthopedic causes

- pancreatitis - pyelonephritis - aortic aneurysm

Pathophysiologic insult of pancreatitis

- inflammation of pancreas - may involve obstruction of pancreatic duct - release of destructive pancreatic enzymes, which autodigest pancreatic tissue

Predisposing factors for pancreatitis

- alcoholism - biliary tract disease - medication use

Discriminating features of pancreatitis

DON'T MISS DX - acute and persistent - epigastric, radiating to back! - relieved somewhat with sitting forward - worse when supine - worse with alcohol or fatty meals - associated with fever, nausea, and vomiting

Physical exam features of pancreatitis

- possible fever and tachycardia - may be ill-appearing with apparent pain - epigastric tenderness, sometimes with abdominal rigidity - may have lower lung crackles or diminished breath sounds (with pleural effusion) - normal back and neurologic exams - ultrasound and CT may show disease - cholangiopancreatography (MR or endocope) may show - pancreatic enzymes elevated - high WBC, anemia - elevated BUN, liver enzymes, bilirubin

Pathophysiologic insult of pyelonephritis

- introduction of bacteria into bladder, ascending up ureters to kidneys - urinary stasis - inflammatory reaction

Predisposing factors for pyelonephritis

- frequent sexual activity or pregnancy - previous UTI or kidney disease - anatomic abnormalities

Discriminating features of pyelonephritis

- acute, gradual onset, progressive pain - lower abdominal or unilateral flank pain - associated fever, chills, nausea, vomiting, dysuria, hematuria, foul urine odor - elderly patients may present with altered mental status!

Physical exam features of pyelonephritis

- fever, tachycardia - may be ill-appearing - vomiting and anorexia may lead to dehydration - lower abdominal tenderness - costovertebral angle tenderness on palpation - urinalysis, urine culture, and/or renal ultrasound may show

Pathophysiologic insult of aortic aneuysm

- weakness in one or more layers of vessel wall - dilation of blood vessel often with blood accumulation in vessel wall - pressure may increase and lead to rupture

Predisposing factors for aortic aneurysm

- men - elderly - tobacco and alcohol use - atherosclerosis, HTN, trauma, syphilis

Distinguishing features of aortic aneurysm

- acute, acute on chronic, or chronic - acute severe pain associated with dissection - may have thoracic "tearing" chest pain or vague abdominal pain - assoc. features depend on location

Physical exam features of aortic aneurysm

- if thoracic: - bradycardia - differences in right carotid and left radial pulses - asymmetric arm blood pressures - if abdominal: - pulsatile mass in central abdomen - aortic bruit

Back pain Flashcards

(38 cards)