Flotsam and Jetsam I
Radiculopathy and Cauda Equina
Physical Examination
(and Treatment)
More Treatment
Flotsam and Jetsam II
100
Name 5 risk factors for chronic back pain
What are: Smoking Obesity Older age Female gender Physically strenuous work Physically sedentary work Low educational attainment Worker's compensation insurance Job dissatisfaction Concurrent mental illness
100
Define sciatica
What is sharp or burning pain radiating down the posterior or lateral aspect of the leg to the foot or ankle
100
This is how the straight leg raise test is performed - demonstrate and describe
What is raising the leg with ankle dorsiflexed, sciatica pain is reproduced between 10 and 60 degrees of elevation?
100
True or False - Patients with acute low back pain will recover slightly faster if they employ bed rest
What is FALSE Multiple randomized controlled trials show recovery either equal or faster without bed rest.
100
There are indications for referral of a patient with low back pain to a neurosurgeon or orthopedic surgeon specializing in back surgery
What are: Cauda equine syndrome...Suspected spinal cord compression...Progressive or severe neurologic deficit...Neuromotor deficit that persists after 4-6 weeks conservative therapy
200
The percentage of patients (within 10%) in whom a physiologic cause of back pain cannot be found
What is 85%?
200
The two nerve roots most frequently involved in radiculopathies
What are L5 and S1?
200
These are examples of Waddell's signs for nonorganic causes of back pain - name 3
What is: Superficial tenderness...Distracted SLR discrepancy...Overreaction during exam...Non-dermatomal distribution of sensory loss...Sudden giving way during motor exam...Inconsistency in observed physical activity...Pain elicited by axial loading
200
True or False - A Medrol dose-pack may hasten return-to-work time by about 48 hrs in a patient with acute low back and radicular pain
What is False False False!
200
This is the percentage of asymptomatic adult patients with bulging intervertebral disks seen incidentally on CT or MRI of the L-S spine
What is 50%?
300
Name 3 signs/symptoms which might prompt you to search for underlying systemic disease as the cause of back pain
What are: History of cancer...New onset with age over 50...Unexplained weight loss...Duration of pain greater than 1 month...Nighttime pain...Unresponsiveness to previous therapies...History of abdominal aortic aneurism
300
Sciatica caused by disc herniation will increase with the following maneuvers
What are: Coughing...Sneezing...Val salva
300
This medication class has the best proven efficacy for acute exacerbations of chronic low back pain
What are NSAIDs? But there are significant side effects to consider and counsel patients about including GI, renal and cardiovascular
300
True or false - Massage therapy has been shown to hasten the resolution of acute low back pain
What is False? However, patients who receive massage therapy have better patient satisfaction scores than patients who receive conventional medical therapy
300
Define spondylosis
What is arthritis of the spine - seen on imaging as disc space narrowing and arthritic changes of the facet joints?
400
The percentage of patients with back pain (and no red flag symptoms) who will improve within 2 weeks with no treatment - within 10%
What is 90%? ACP and APS recommend "Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain" and reserve imaging for patients with severe or progressive neurologic deficits or when serious underlying conditions are suspected. Consider plain films of L-S spine if sx not improved after 4-6 weeks
400
The common symptoms of cauda equine syndrome - name at least 3
What are: Urinary retention with overflow...Saddle anesthesia...Bilateral sciatica...Leg weakness
400
True or False - Muscle relaxants have some proven efficacy for the treatment of low back pain
What is False? Only one trial has evaluated a US-marketed muscle relaxant (Cyclobenzaprine) for chronic back pain and there were no differences in muscle spasm scores compared to placebo
400
True or false - Acupuncture is effective for the treatment of chronic low back pain
What is sortof true? A 2005 systematic review concluded there is moderate evidence of short-term benefit for use of acupuncture for chronic back pain. The evidence on benefit for acute back pain was inconclusive.
400
Define spondylolisthesis
What is anterior displacement of a vertebra on the one beneath it? Grades I-IV: Grade I=1-25% slip; Grade II=26-50% slip; Grade III=51-75% slip; Grade IV=76-100% slip. Usually only Grades II and IV require surgical intervention
500
"Pseudoclaudication" aka "neurogenic claudication" is typically seen in what condition
What is spinal stenosis? **pain with walking localized to the calf or distal leg, resolving with rest**differentiated from true claudication by the presence of normal arterial pulses
500
Show us the dermatome involving the L5 nerve root
What is .... For 100 points extra, show us the dermatome involving the S1 nerve root
500
Describe and demonstrate the components of physical examination for low back pain
What is: inspection to assess for kyphosis, lordosis, scoliosis, rashes; palpation to assess for vertebral tenderness; strength, sensation and reflex testing of the legs; straight-leg raise if lumbar radiculopathy suspected; range of motion
500
True or false - Glucosamine has demonstrated effectiveness in the management of chronic back pain due to osteoarthritis
False - Glucosamine has only been shown to be beneficial for the treatment of some patients with osteoarthritis of the knee
500
Define spondylolysis
What is a fracture in the pars interarticularis where the vertebral body and the posterior elements (which protect the nerves) are joined?
M
e
n
u