Case 10: 45-year-old male with low back pain
This is the 5th most common reason for all doctor visits = - correct answer Low back pain
Most low back pain resolves in this amount of time = - correct answer 2-4 weeks
Three major categories of back pain = - correct answer - *Mechanical* = no primary
inflammatory or neoplastic cause
- *Visceral* = no primary involvement of the spine, usually from internal organs
- *Non-mechanical*
3 most common causes of back pain = - correct answer 1. *lumbar strain/sprain* - 70%
2. *age-related degenerative joint changes in the disks and facets* - 10%.
3. *herniated disc* - 4%
These are red flags for serious illness or neurological impairment a/w back pain = - correct
answer Fever
Unexplained weight loss
Pain at night
Bowel or bladder incontinence
Neurologic symptoms
Saddle anesthesia
Lower back pain worse with movement and sitting is suggestive of a mechanical cause of back
pain, such as = - correct answer - Lumbar strain
- Disc herniation
- Degenerative arthritis
Lower back pain that radiates down the leg and numbness indicate nerve involvement,
suggestive of = - correct answer Disc herniation
Lower back pain that improves with the supine position suggests the following = - correct
answer - Spinal stenosis
- Disc herniation
Cauda equina syndrome requires the following treatment = - correct answer Emergency
decompression within 72 hours
, Cauda equina syndrome is more likely diagnosis if the patient has the following symptoms = -
correct answer Problems with bowel or bladder control
Back pain due to malignancy is described as = - correct answer - localized to the affected bones
- dull, throbbing pain that progresses slowly
- increases with recumbency or cough
Ankylosing spondylitis = - correct answer *Chronic*, painful, inflammatory arthritis primarily
affecting *spine and sacroiliac joints,* causing eventual *fusion of the spine*
Ankylosing spondylitis presenting symptoms = - correct answer Morning stiffness and achiness
over the sacroiliac joint and lumbar spine
Spondylolisthesis = - correct answer *Anterior displacement* of a vertebra or the vertebral
column in relation to the vertebrae below
Spondylolisthesis presenting symptoms = - correct answer - Aching back and posterior thigh
discomfort
- Increases with activity or bending
Restriction and pain during lumbar flexion are suggestive of = - correct answer Herniation
Osteoarthritis
Muscle spasm
Pain with lumbar extension is suggestive of = - correct answer Degenerative disease
Spinal stenosis
During lateral motion, pain on the same side as bending is suggestive of this type of pathology =
- correct answer BONE pathology (e.g. osteoarthritis or neural compression)
During lateral motion, pain on the opposite side of bending is suggestive of this type of
pathology = - correct answer MUSCLE strain
Difficulty with heel walk is a/w disc herniation at this level = - correct answer *L5*
Difficulty with toe walk is a/w disc herniation at this level = - correct answer *S1*
In patients with central spinal stenosis, this movement will reduce pain = - correct answer
SQUATS
Patellar tendon reflex tests these nerve roots = - correct answer L3 and L4
Medial hamstring reflex tests this nerve root = - correct answer L5
Achilles tendon reflex tests this nerve root = - correct answer S1
This is the 5th most common reason for all doctor visits = - correct answer Low back pain
Most low back pain resolves in this amount of time = - correct answer 2-4 weeks
Three major categories of back pain = - correct answer - *Mechanical* = no primary
inflammatory or neoplastic cause
- *Visceral* = no primary involvement of the spine, usually from internal organs
- *Non-mechanical*
3 most common causes of back pain = - correct answer 1. *lumbar strain/sprain* - 70%
2. *age-related degenerative joint changes in the disks and facets* - 10%.
3. *herniated disc* - 4%
These are red flags for serious illness or neurological impairment a/w back pain = - correct
answer Fever
Unexplained weight loss
Pain at night
Bowel or bladder incontinence
Neurologic symptoms
Saddle anesthesia
Lower back pain worse with movement and sitting is suggestive of a mechanical cause of back
pain, such as = - correct answer - Lumbar strain
- Disc herniation
- Degenerative arthritis
Lower back pain that radiates down the leg and numbness indicate nerve involvement,
suggestive of = - correct answer Disc herniation
Lower back pain that improves with the supine position suggests the following = - correct
answer - Spinal stenosis
- Disc herniation
Cauda equina syndrome requires the following treatment = - correct answer Emergency
decompression within 72 hours
, Cauda equina syndrome is more likely diagnosis if the patient has the following symptoms = -
correct answer Problems with bowel or bladder control
Back pain due to malignancy is described as = - correct answer - localized to the affected bones
- dull, throbbing pain that progresses slowly
- increases with recumbency or cough
Ankylosing spondylitis = - correct answer *Chronic*, painful, inflammatory arthritis primarily
affecting *spine and sacroiliac joints,* causing eventual *fusion of the spine*
Ankylosing spondylitis presenting symptoms = - correct answer Morning stiffness and achiness
over the sacroiliac joint and lumbar spine
Spondylolisthesis = - correct answer *Anterior displacement* of a vertebra or the vertebral
column in relation to the vertebrae below
Spondylolisthesis presenting symptoms = - correct answer - Aching back and posterior thigh
discomfort
- Increases with activity or bending
Restriction and pain during lumbar flexion are suggestive of = - correct answer Herniation
Osteoarthritis
Muscle spasm
Pain with lumbar extension is suggestive of = - correct answer Degenerative disease
Spinal stenosis
During lateral motion, pain on the same side as bending is suggestive of this type of pathology =
- correct answer BONE pathology (e.g. osteoarthritis or neural compression)
During lateral motion, pain on the opposite side of bending is suggestive of this type of
pathology = - correct answer MUSCLE strain
Difficulty with heel walk is a/w disc herniation at this level = - correct answer *L5*
Difficulty with toe walk is a/w disc herniation at this level = - correct answer *S1*
In patients with central spinal stenosis, this movement will reduce pain = - correct answer
SQUATS
Patellar tendon reflex tests these nerve roots = - correct answer L3 and L4
Medial hamstring reflex tests this nerve root = - correct answer L5
Achilles tendon reflex tests this nerve root = - correct answer S1
