| Mechanism | History and physical | |
| MUSCULOLIGAMENTOUS SPRAIN\STRAIN | – MCC of back pain
– Sprain = ligament – Strain = muscle |
– After lifting heaving object\bending\twisting
– LBP radiates to buttocks\post thigh – Local tenderness + limited spinal motion |
| DISC HERNIATION | – MC post or post\lat of nucleus pulposus -> nerve impingement
– MC at L4-5 and L5-S1 |
– LBP radiates to LL
– Sharp\shooting\burning\electricity – Weakness + paresthesia of LL – Improves w\ rest – Worse w\ Valsalva, sneezing, coughing – Positive straight leg raise |
| SPINAL STENOSIS | – In older adults ≥ 50
– Can be congenital – Arthritic changes -> narrowing of bony spaces in spine -> nerve compression |
– LBP radiates to LL (usually bilateral)
– Pseudoclaudication (neurogenic claudication) – Relieved by sitting, bending, laying down – Worse w\ walking (esp up an incline) |
| SPONDYLOLISTHESIS | – Forward slippage of cephalad vertebra on the caudal vertebra
– MC at L4-5 and L5-S1 |
– LBP radiates to post thigh
– Exaggeration of lumbar curve – Palpable “step-off” – Tight hamstrings |
| CAUDA EQUINE SYNDROME | – Extension of the dural-arachnoid sac beyond the inf tip of spinal cord and terminal nerve roots -> acute disc herniation
– Caused by trauma or neoplasms – EMERGENCY! |
– Urinary retention\overflow incontinence
– Change in bowel habits\fecal incontinence – Lower extremity weakness – Saddle anesthesia (perianal region) – ↓ rectal tone – ↓ bulbo-cavernous reflex |
| VERTEBRAL COMPRESSION FRACTURE
|
– Caused by minor trauma in elderly or pts on long-term steroids | – Acute back pain at level of fx
– Local radiation to back\around trunk – Kyphosis |
| ANKYLOSING SPONDYLITIS | – Young\male
– HLA-B27 |
– Pain over the sacroiliac joint
– Morning stiffness – Hx of IBD – ↓ chest expansion – Bamboo-spine in radiograph |
| NEOPLASM | – MC is metastasis
– Breast, lung, prostate, kidney, thyroid Ca |
– Night pain
– Not relieved by supine position – Worse w\ recumbence or cough – Constitutional symptoms (fever) |
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References:
- Case files – family medicine
- Blue print
