Back Pain

  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)

 


Download the PDF version: here


References:

  • Case files – family medicine
  • Blue print

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