Low back pain

Combinations of abnormal findings for herniated disc are?

( positive straight leg raise and neurologic abnormalities such as absent ankle reflex, impaired plantar or dorsiflexion, impaired sensation in L5-S1 distribution)

A positive test Straight leg test reproduces the patient's sciatica when the leg is elevated between

30 and 60 degrees

Risk factors for persistent low back pain include?

A history of previous back pain, Depression, Substance abuse, Pending or past litigation or disability compensation, Low socioeconomic status, Work dissatisfaction

classic presentation of herniated disk is?

moderate to severe pain radiating from the back down the buttock and leg, usually to the foot or ankle, with associated numbness or paresthesias. This type of pain is called sciatica, and it is classically precipitated by a sudden increase in pressure on the disk, such as after coughing or lifting

Low back pain History and physical exam should focus on what?

neurologic signs and symptoms that would suggest a specific musculoskeletal cause, such as a herniated disk, and for signs and symptoms that would suggest the presence of a systemic disease.

classic presentation of mechanical back pain is

nonradiating pain and stiffness in the lower back, often precipitated by heavy lifting.

97% of the back pain seen in a primary care practice is caused by?

nonspecific mechanical back pain

pain is worsened by sitting and radiates down the back of leg which suggests

sciatic pain and possibly herniated disk especially after unusual exertion

A straight leg raise test that elicits back pain is negative for?

sciatica Sciatica refers to what?///pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve

Risk factors for herniated disk include

sedentary activities, especially driving, chronic cough, lack of physical exercise, and possibly pregnancy. Jobs involving lifting and pulling have not been associated with increased risk

Back Pain Due to Metastatic Cancer classic presentation is?

the development of constant, dull back pain that is not relieved by rest and is worse at night in a patient with a known malignancy

What aggravates herniated disc patients pain?///Coughing,

Coughing, sneezing, or prolonged sitting can aggravate the pain.There are no bowel or bladder symptoms with unilateral disk herniations

Cauda equina syndrome clinical clues and tests to order include?

Urinary retention, Saddle anesthesia, Bilateral sciatica, Leg weakness, Decreased anal sphincter tone. Test to order is a MRI

Acute low back pain treatment include which medications?

acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDS), and skeletal muscle relaxants are effective in relieving acute low back pain.

Herniated disk patients can have Numbness, paresthesias, and motor weakness found variably and can occur in the absence of what symptom?

any of these can occur in the absence of pain.

Disk disease is frequently?

asymptomatic

Nonspecific back pain of musculoskeletal structures characteristics and examples?

-a specific anatomic diagnosis cannot be made -no neurologic signs or symptoms. -It is nonprogressive. a. Examples include the following: (1) Lumbar strain and sprain (2) Degenerative processes of disks and facets (3) Spondylolisthesis (anterior displacement of a vertebra on the one beneath it) (4) Spondylolysis (defect in the pars interarticularis of the vertebra) (5) Scoliosis

Specific back pain of musculoskeletal structures characteristics and examples?

-specific anatomic diagnosis can often be made. -Neurologic signs and symptoms are present. -It can be progressive. f. Examples include the following: (1) Herniated disk (2) Spinal stenosis (3) Cauda equina syndrome

Treatment for herniated disk in the absence of cauda equina syndrome or progressive neurologic dysfunction include the following? conservative therapy should be tried for 1 month. NSAIDs are the first choice, Opioids are often necessary, Bed rest does not accelerate recovery, Epidural corticosteroid injections may provide temporary pain relief.

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not useful for isolated back pain) Plain radiographs do not image herniations

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Back pain due to visceral disease is serious and often requires specific and rapid diagnosis and treatment, visceral diseases that cause back pain include?

1. Retroperitoneal a. Aortic aneurysm b. Retroperitoneal adenopathy or mass 2. Pelvic a. Prostatitis b. Endometriosis c. Pelvic inflammatory disease 3. Renal a. Nephrolithiasis b. Pyelonephritis c. Perinephric abscess 4. GI a. Pancreatitis b. Cholecystitis c. Penetrating ulcer

Back pain due to systemic disease affecting the spine include

1. Serious, requiring specific and often rapid treatment a. Neoplasia (1) Multiple myeloma, metastatic carcinoma, lymphoma, leukemia (2) Spinal cord tumors, primary vertebral tumors c. Infection (1) Osteomyelitis (2) Septic diskitis (3) Paraspinal abscess (4) Epidural abscess 2. Serious, requiring specific treatment but not necessarily immediately a. Osteoporotic compression fracture b. Inflammatory arthritis (1) Ankylosing spondylitis (2) Psoriatic arthritis (3) Reiter syndrome (4) Inflammatory bowel disease-associated arthritis

Define mechanical back pain and give examples?

A mechanical problem is due to the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Another cause of back pain is the wearing down of the facet joints, which are the large joints that connect each vertebrae to another. Other mechanical causes of back pain include spasms, muscle tension, and ruptured discs, which are also called herniated discs.

Compression fracture of the spine clinical clues and test to order include?

Age is greater than 70 year old, Significant trauma, History of osteoporosis, and Corticosteroid use. The test to order is a MRI and spine radiograph

Avoid what kind of activity when having acute low back pain?

BED REST. Best rest does not help pain and will just prolong duration of pain, NSAIDS, heat, and activity as tolerated is the best approach followed by specific daily back exercises

Imaging test for viewing disk herniation that are used are?

CT and MRI scans have similar test characteristics for diagnosing herniated disks. Electromyography (Might be useful in assessing possible nerve root dysfunction in patients with leg symptoms lasting more than 4 weeks

Mechanical back pain can have stiffness in the back and also what other two areas?

Can also have pain and stiffness in the buttocks and hips

cauda equina syndrome definition and symptoms include?

Cauda equina syndrome is a rare condition caused by tumor or massive midline disk herniations. It is characterized by the following:Urinary retention, Urinary incontinence, Decreased anal sphincter tone, Sensory loss in a saddle distribution, Bilateral sciatica, Leg weakness

Herniated disk back pain clinical clues and tests to order include?

Clinical clues are Sciatica, Abnormal neurologic exam, especially in L5-S1 distribution. The Tests to order are CT or MRI.

back pain due to malignancy: clinical clues and tests to order include?

Duration of pain is more than 1 month, Age is greater than 50 year old, Previous cancer history, Unexplained weight loss of more than 10 pounds over 6 months. Test to order to rule out malignancy are spine radiograph and MRI

back pain due to infection: clinical clues and tests to order include?

Fever, Chills, Recent skin or urinary infection, Immunosuppression,Injection drug use. Test to order is a MRI

Mechnical back pain generally occurs after what activity and what position improves the back pain?

Generally occurs hours to days after a new or unusual exertion and improves when the patient is supine

Ruling out cancer in low back pain includes the following characteristics

If the patient is younger than 50 years, has no history of cancer, has not experienced unexplained weight loss, and has not failed conservative therapy, cancer is not likely to be the cause of back pain

Surgery is indicated for herniated disk if the following are present?

Impairment of bowel and bladder function (cauda equina syndrome),Gross motor weakness, Progressive neurologic symptoms or signs

98% of clinical disk herniations are caused by which vertebrae regions?

L4-L5 and L5-S1 cause, so pain and paresthesias are most often seen in these distributions. What aggravates herniated disc patients pain?Coughing, sneezing, or prolonged sitting can aggravate the pain.

Imaging and laboratory tests for cancer as the cause of low back pain?

MRI scan is the best test for diagnosing or ruling out cancer as a cause of back pain and for deter mining whether there is cord compression.Laboratory test include the erythrocyte sedimentation rate (ESR) which is sometimes helpful.

Herniated disc patients who have positive straight leg test, should feel what during the test?

The patient should describe the pain induced by the maneuver as shooting down the leg, not just a pulling sensation in the hamstring muscle

The medication treatments for Subacute or chronic low back pain include the following?

Tricyclic antidepressants, tramadol, opioids, gabapentin, and benzodiazepines, the best evidence is for tricyclic antidepressants

Crossed straight leg test is performed by lifting the contralateral leg

a positive test reproduces the sciatica in the affected leg

Mechanical back pain clinical clues and tests to order

absence neurologic signs and symptoms signs and symptoms that suggest specific musculoskeletal cause and sign and symptoms that would suggest the presence of a systemic disease, resolution within 3 to 4 weeks.

Does specific back exercises help acute low back pain?

back exercises do not help back pain but help prevent recurrent back pain, it is a long-term intervention

Treatments that do not include medication for subacute or chronic low back pain include the following

cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are effective for chronic low back pain. There is fair evidence that acupuncture, massage, and some yoga techniques are effective

How often is anatomic diagnosis made in mechanical back pain?

diagnosis is rarely made for a specific anatomic diagnosis

What are non-medication treatments for acute low back pain?

heat and spinal manipulation

Straight leg test is performed by?

holding the heel in 1 hand and slowly raising the leg, keeping the knee extended

Most common site of weakness in herniated disk patient?

is foot plantar or dorsiflexion in hernited disk patient