Neurology > Low Back Pain and Sciatica > Flashcards

Low Back Pain and Sciatica Flashcards

(45 cards)

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1
Q

What questions would you ask about character of back pain?

A
  • Dull
  • Stabbing
  • Throbbing
  • Burning
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2
Q

What questions would you ask about location and radiation of back pain?

A

Buttocks (muscle)

Below knee (maybe disc)

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3
Q

What questions would you ask about duration of back pain?

A

Acute vs subacute vs chronic

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4
Q

What associated symptoms of back pain need to be assessed?

A

Stiffness

Numbness/tingling

Urinary symptoms

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5
Q

What aggravating factors of back pain need to be assessed?

A

Certain positions (sitting)

Coughing

sneezing

Walking down the stairs

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6
Q

What relieving factors of back pain need to be assessed?

A
  • Certain positions
  • Non-pharmacological measures (massage, osteopath, acupuncture, PT)
  • Analgesia
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7
Q

Describe a history for back pain?

A

Past medical history

History of PC

  • onset
  • character
  • location and radiation
  • duration
  • intensity
  • associated symptoms

Systems review

Medical and surgical history

Drug history

Family History

Social History

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8
Q

What systems reviews need to be done in a presentation of back pain?

A
  • fever
  • appetite/weight loss
  • abdominal pain
  • cough/haemoptysia
  • dysuria/haemoturia
  • menstrual history
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9
Q

What questions about medical and surgical history must be asked?

A

Trauma

Previous operations including spine

Malignancy

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10
Q

What questions about drug history must be asked?

A

Corticosteroids

Immunosuppressants

Anti-platelet

Anticoagulant

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11
Q

What questions about family history must be asked?

A

Cancers

Back pain/spondyloarthropathies

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12
Q

What questions about social history must be asked?

A

Job (type of work, ?physical, level of activity)

Smoking history

Recreational drug use

Sporting activities

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13
Q

What needs to be determined and ruled out in a patient with lower back pain?

A

Determine the pain is intrinsic from the back and not referred from elsewhere

Rule out life-threatening disease

Determine whether root compression is present

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14
Q

What are the general red flags of back pain?

A
  • Failure to improve after 4-6 weeks of conservative therapy
  • Unrelenting night pain or pain at rest
  • Progressive motor or sensory deficit
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15
Q

What are the cancer red flags of back pain?

A
  • Age > 50
  • unintended weight loss
  • history of cancer
  • pain at night and in recumbency
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16
Q

What are the infection red flags of back pain?

A
  • fever/chills
  • recent infection
  • immunosuppression
  • IV drug use
  • Dental status
  • Foreign travel
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17
Q

What are the fracture red flags of back pain?

A
  • age > 50
  • osteoporosis
  • significant trauma
  • chronic steroid use
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18
Q

What are the cauda equina syndrome red flags for back pain?

A
  • bilateral sciatica
  • urinary incontinence
  • leg weakness
  • decreased anal tone
  • Loss of perianal sensation
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19
Q

What are the AAA red flags of cauda equina syndrome?

Study These Flashcards
A
  • Age > 60
  • Abdominal pulsating mass
  • Pain at rest
20
Q

Describe examination in back pain

Study These Flashcards
A
  • general appearance
  • vital signs
  • back examination
    • GAIT
      • heels
      • tip toes
    • LOOK: from side and back
    • FEEL: SPs, steps, SI joints
    • MOVE: flexion, extension, lateral bending, rotation
  • other tests
    • SLR
    • muscle strength
    • sensation
    • deep tendon reflexes
21
Q

Each joint movement consists of 4 consecutive spinal nerves;

Hip flexion ___and extension ___

Knee flexion ___ and extension ___

Ankle plantarflexion ____ and dorsiflexion ____
Foot inversion ___ and eversion ____.

Study These Flashcards
A

Each joint movement consists of 4 consecutive spinal nerves;

Hip flexion L2,3 and extension L4,5

Knee flexion L5,S1 and extension L3,4

Ankle plantarflexion S1,2 and dorsiflexion L4,5
Foot inversion L4 and eversion L5,S1.

22
Q

Describe the grading of muscle power

Study These Flashcards
A

0- Complete paralysis

1- Flicker of contraction possible

2- Movement possible if gravity eliminated

3- movement against gravity but not against resistance

4- movement possible against some resistance

5- power normal (it is not normally possible to overcome a normal adult’s power)

23
Q

Sensation across foot on both dorsal and plantar surfaces from medial to lateral is __-__-__

Study These Flashcards
A

Sensation across foot on both dorsal and plantar surfaces from medial to lateral is L4-L5-S1

24
Q

Myotome dance

Neck flexion: __

Side bending: __

Shoulder elevation: __

Shoulder abductinon: __

Elbow flexion, wrist extension: __

Elbow extension, wrist flexion: __

Thumb extension: __

Finger abdunction: __

T2-T12

Hip flexion, knee extension, ankle dorsiflexion: __,_,_

Ankle dorsiflextion, toe extension: __-_

Hip extension: __

Knee flexion: __

Study These Flashcards
A

Myotome dance

Neck flexion: C2

Side bending: C3

Shoulder elevation: C4

Shoulder abductinon: C5

Elbow flexion, wrist extension: C6

Elbow extension, wrist flexion: C7

Thumb extension: C8

Finger abdunction: T1

T2-T12

Hip flexion, knee extension, ankle dorsiflexion: L2,3,4

Ankle dorsiflextion, toe extension: L4-5

Hip extension: S1

Knee flexion: S2

25
Which nerve roots are being compressed?
L4, L5, S1
26
What spinal nerves are responsible for Triceps reflex: Biceps reflex: Patellar reflex: Achilles reflex:
Triceps reflex: C7, C8 Biceps reflex: C5, C6 Patellar reflex: L2, L3, L4 Achilles reflex: S1
27
What investigations are done for non resolving back pain?
**Radiology** - X-ray - CT - MRI - Bone scan - PET/SPECT **Lab** - FBC, U&E'S - Inflammatory markers
28
When should x-rays be used?
NOT ROUTINELY Young men: SI joint to exclude ank spon Elderly: to exclude vertebral collapse, other fractures, malignancy X-rays for deformity
29
CTs have a limited application in acute LBP without....
Red flags
30
What are CTs good for?
Bony pathology (trauma, tumours, infection) Good: foreign bodies, implants Spinal fusion planning MRI contraindicated/not available
31
What is MRI good for?
Details of soft tissues (including tumours, infection) Some sequences good for new fractures Bone oedema/microfractures
32
Red flags --\> \_\_\_ Neurological signs and symptoms --\> \_\_\_
Red flags --\> MRI Neurological signs and symptoms --\> MRI
33
What is a radionucleotide bone scan used for?
**Increased bone turnover** *-fractures, osteomyelitis, paget's disease, ank spondlyitis* **Metastases** **Tumours** *-Osteoid* *osteoma*
34
What will PET scan show?
Increased uptake in high turnover areas
35
Which laboratory tests are indicated if red flags are present?
* malignancy (PSA, acid phosphatase, monoclonal bands) * Infection * Metabolic causes (alk phos, Ca2+, PO4, HLA B-27)
36
What non-pharmacological intervention is there?
* Explanation * Re-assurance * No bed rest
37
What are the pharmacological interventions for LBP?
* Regular analgesia, incl NSAIDS * Improve mobility * Facilitate exercise * Opiates for severe pain * Short term * Breakthrough only * TCAs * Injections
38
What complementary and alternative medicine interventions are there?
* acupuncture * chiropractor * osteopath * massages * physiotherapy
39
When should LBP be investigated?
No improvement after 4-6 weeks Red flags
40
When should LBP be referred?
* Intractable pain * Serious pathology suspected or suggested on initial imaging * Neurological deficit
41
What are the risk factors for LBP?
* previous back pain * heavy lifting/frequent bending * repetitive work with exposure to vibration
42
What are the best ways of preventing back pain?
* education * lifting, turning * mental coping strategies * stop smoking * physical activity
43
What is the treatment plan for sciatica?
Initially conservative Unless red flags: surgical intervention
44
What is the DDx of sciatica?
* Root compression by other **degenerative disease** * *bone spurs, canal stenosis, spondylolisthesis, facet arthropathy* * Root compression of **sinister causes** * *(tumour, fractures, TB)* * Root compression **outside the spine** * (*piriformis syndrome, endometriosis, pelvic disease,peroneal compression...)* * No root compression * *(arachnoiditis, peripheral neuropathies)*
45
What is piriformis syndrome?
Tight piriformis compresses sciatic nerve
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