What are red flags for cauda equina syndrome?
- saddle anaesthsia or paraesthesia
- recent onset bladder dysfunction or faecal incontinence
- perianal/ perineal sensory loss
- unexpected laxity of anal sphincter
- severe or progressive neurological deficit in lower extremities
How is cauda equina syndrome managed in primary care
Send straight to hospital for assessment by a neurosurgeon
What are red flags indicating spinal fracture?
- sudden onset severe central pain relieved by lying down
- major trauma
- minor trauma with known or suspected osteoporosis
- point tenderness over vertebral body
- structural deformity of spine
What are red flags indicating cancer of infection presenting with back pain?
- pain that remains when lying down, aching at night time, stopping sleep
- age >50 or <20
- history of cancer
- constitutional symptoms
- recent bacterial infection (eg UTI)
- IV drug misuse
- immune surpresion
- scoliosis/ other defority
- ## point tenderness over vertebral body
What bone cancers most commonly metastasise to bone?
bronchus breast prostate thyroid kidney
What bone disorders could cause back pain?
- pagets disease of bone
- osteoporosis (leads to vertebral collapse)
- spinal stenosis- often due to OA (leads to sciatica)
How does ank spond tend to present
- slow onset and in men <40
- ridgid back with marked morning stiffness
- aggravation by inactivity and releived by movement
Other than ank spond what inflammatory diseases could cause back pain?
- psoiratic arthritis
- reactive arthritis
- arthropathies associated with IBS
All the seronegative spondyloarthropathies
What infections can cause back pain?
- tubercolosis
- HIV
- pyelonephritis
- discitis
how would mechanical back pain present?
sudden onset, worse on moving, triggered by lifting/ lifts a lot fo job, tenderness to paraspinal muscles, hard to get into comfortable position,
How is mechanical back pain managed?
- reassurance and positive attitude
- advice to stay active as possible
- regular pain relief, inc topical NSAIDs
- short course diazepam if they have a muscle spasm
- for those at risk of poor outcome, refer to group exercise program or/ and physio
- advice on lifting technique and posture
Which joints are most commonly affected by OA? (3)
- hips
- knees
- small joints of hands
Give 4 risk factors of OA?
- FHx
- ageing
- female
- obesity
- PMH joint injury
- occupational and recreational stresses on joints
- joint laxity or malalignment
What are the 3 major criteria for making a clinical diagnosis of osteoarthritis/
- age >45 yrs
- activity related joint pain
- no morning stiffness or stiffness lasting <30 mins
Where is hip OA pain often felt?
groin and anterior or lateral thigh, it is also often referred to the hip, in males it often refers to the testicles on the affected side
Give 4 signs of OA
- reduced ROM
- pain on movement
- fixed flexion deformity
- joint effusion/ synovitis
- periarticular tenderness
- crepitus
- abscence of systemic features/ rash
- bony swellings and deformity due to osteophytes
- Heberdens and bouchards nodes
How can severity of OA be assessed?
oxford hip and knee scores
What are the fundementals of OA treatment? (9)
- education
- exercise
- weight loss
- PRICE
- braces, joint supports, assistive devices
- physiotherapy and occupational therapy
- podiatrists can help with insoles etc
- analgesia
- steroid injections
- joint surgery
