Term
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Definition
Major Systems (CT MIND V)
Congen: scoliosis/kyphosis
Toxic/Trauma: Lumbar strain, compression fracture
Metabolic: osteoporosis, hyperpara, pagets disease
Infect: Pyelonephritis, osteomyelitis, herpes zoster
Neoplastic: Mult. Myeloma, mets, lymphoma/leukemia
Degenerative: disc herniation, osteo arthritis, spinal stenosis
Vascular: Aortic Aneurysm
Visceral: Prostatitis, PID, ovarian cyst, kidney stones, pancreatitis |
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Term
| Risk factors for mechanical Lower back pain |
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Definition
| prolonged sitting, deconditioning, suboptimal lifting, radiologic findings, maybe obesity |
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Term
| (T/F)) most back pain is acute and resolves within 1 month |
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Definition
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Term
| Clinical features of disc herniation |
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Definition
| Pain that radiates down leg, parasthesias, ~foot drop, inc pain with coughing and sneezing |
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Term
Back Exam:
Lumbar pain with flexion suggests?
pain with extension?
difficulty with heel walk? and toe walk? |
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Definition
pain with flexion suggests herniation, osteoarthritis, or muscle spasm
pain with extension suggests degenerative disease or spinal stenosis
difficulty with heel walk: L5 herniation
difficulty with toe walk: S1 herniation
Stroop test: standing to squatting-->releif of pain in spinal stenosis |
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Term
Neuro Back exam
L3-
L4-
L5-
S1- |
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Definition
L3-paellar tendon, extend quads, squat
L4-patellar tendon, dorsiflex ankles, walk on heels
L5-medial hamstring, dorsiflex great toe, walk on heels
S1- achilles tendon, plantar flex ankle, walk on toe |
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Term
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Definition
| Passive straight leg raise (tests for disc herniation), crossed leg raise, FABER test (pathology of hip joint) |
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Term
| Clinical features of cuada equina syndrome |
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Definition
| medical emergency, decompression needed. Mass effect-> pain radiating down the leg and numbness of leg. Pain is worse w movt and sitting (improves with lying down). Red flags: neurological deficits, dificulty urinating or fecal incontinence |
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Term
| Red flags for cancer in lower back pain |
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Definition
| Unrelenting night pain, pain at rest, unexplained weight loss, Hx of cancer |
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Term
| Red flags for infection w lower back pain |
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Definition
| persistent fever (>100.4), fever/chills, risk of recent bacterial infection, IV drug abuse, immune suppression. |
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Term
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Definition
| major or minor trauma, chronic steroid use |
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Term
| Studies for lower back pain |
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Definition
If no red flags, wait 6 weeks of conservative threrapy, then plain radiograph (and then ~CT)
CBC to rule out cancer or infection
Xray (age>50, weight loss, fever, ankylosing spondylitis)
MRI (if neurological defect, radiculopathy, cuada equina) |
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Term
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Definition
Conservative therapy (NSAID, muscle relaxants, rest but maintain activity,)
Physical therapy |
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