back pain + sciatica

Question 1

lumbago

Answer 1

low back pain

Question 2

acute low back pain should improve within…

Answer 2

1-2wks

Question 3

sciatica recovery time

Answer 3

4-6wks

Question 4

management aims for lower back pain

Answer 4

• identify serious underlying pathology
• speed up recovery
• reduce risk chronic lower back pain
• manage Sx in chronic LBP

Question 5

caused of mechanical back pain

Answer 5

muscle/ligament sprain 
facet joint dysfunction 
SI joint dysfunction 
herniated disc
spondylolithesis 
scoliosis 
degenerative changes

Question 6

causes of neck pain

Answer 6

muscle/ligament sprain
torticollis
whiplash
cervical spondylosis

Question 7

torticollis

Answer 7

waking up with a unilaterally stiff and painful neck due to muscle spasm

Question 8

red flag causes of back pain

Answer 8

spinal fracture - major trauma
cauda equina - saddle anaesthetsia, incontinence, bilateral neuro signs
ankylosing spondylitis
spinal infection - fever, Hx IVDU

Question 9

causes of back pain which are unrelated to spine

Answer 9

pneumonia 
ruptured AAA
kidney stone 
pyelonephritis
pancreatitis
prostatitis
PID 
endometriosis

Question 10

sciatic nerve - nerve roots

Answer 10

L4-S3

Question 11

sciatic nerve - exitrs posterior pelvis through

Answer 11

greater sciatic foramen

Question 12

sciatic nerve - divides into

Answer 12

tibial nerve
common peroneal nerve

(at knee)

Question 13

sciatic nerve - sensory function

Answer 13

lateral lower leg and foot

Question 14

sciatic nerve - motor function

Answer 14

posterior thigh

lower leg and foot

Question 15

sciatia - presentation

Answer 15

unilateral buttock pain radiating down leg
paraesthesia
numbness
motor weakness

Question 16

sciatica main cause

Answer 16

lumbosacral nerve root compression

• herniated disc
• spondylolithesis
• spinal stenosis

Question 17

bilateral sciatica

Answer 17

red flad for cauda equina syndrome

Question 18

examination findinfs - localised spinal tenderness

Answer 18

spinal #

cancer

Question 19

examination findinfs -bilateral neuro signs

Answer 19

cauda equina

Question 20

examination findinfs -bladder distension

Answer 20

urinary retention - cauda equina

Question 21

examination findinfs -reduced anal tone

Answer 21

cauda equine

Question 22

Ix - spinal fracture

Answer 22

X-ray or CT

Question 23

Ix - suspected cauda equina

Answer 23

emergency MRI

Question 24

Ix - ankylosing spondylitis

Answer 24

inflammatory markers - CRP, ESR
X-ray (bamboo spine)
MRI

Question 25

STarT back screening tool

Answer 25

risk of patient presenting with acute back pain developing chronic back pain

Question 26

managing acute lower back pain - first steps

Answer 26

1. exclude serious underlying cause | 2. StarT back tool

Question 27

Mx acute back pain - pt at low risk of chronic back pain

Answer 27

``` self management education reassurance analgesia staying active, mobilisation ```

Question 28

Mx acute back pain - pt at med/high risk of chronic back pain

Answer 28

physiotherapy group exercise CBT

Question 29

Mx acute back pain - analgesia

Answer 29

1. NSAIDS first line 2. codeine as alternative 3. benzodiazepines for muscle space (short term up to 5days)

Question 30

Mx acute back pain - analgesia NOT to use

Answer 30

``` opioids antidepressants amitryptiline gabamentin pregabalin ```

Question 31

Mx chronic lower back pain from facet joints

Answer 31

radiofrequency denervation

Question 32

sciatica - pain Mx

Answer 32

amitryptiline | duloxetine

Question 33

sciatica - specialist Mx options

Answer 33

epidural corticosteroid infections local anaesthetic injectins radiofrequency denervation spinal decompression