Most low back pain resolves on its own in this amount of time
2-4 weeks
LBP without red flag symptoms typically needs this kind of imaging
None!
This is by far the most common etiology of LBP
mechanical lumbar strain
persistent pain at night may indicate this etiology of LBP
malignancy
These are the three components of conservative management of uncomplicated LBP
NSAIDs or muscle relaxants
Heat
PT
Pain that is worth at rest most often suggests this dx
lumbar strain
This is the preferred mode of imaging for persistent radiculopathy
MRI
bony point tenderness on back exam suggests this dx
focal fracture
abdominal bruit indicates this uncommon, highly morbid cause of acute back pain
abdominal aortic aneurysm
This is the mainstay of tx for cauda equina syndrome
Surgical decompression
Name at least three symptoms of cauda equina syndrome
Saddle anesthesia
Fecal incontinence
Urinary incontinence
Bilateral LE weakness or numbness
Progressive focal neuro deficits
normal UA would help rule out this cause of LBP
pyelonephritis
these are the second and third most common dx's for LBP
degenerative joint disease
herniated disc
You might worry about these two dxs in a patient whose LBP is associated with fever and recent endocarditis
-epidural abscess
-osteomyelitis
This class of drugs can reduce the incidence of vertebral fracture in elderly patients
bisphosphonates (eg alendronate)
if a standing bend to the side provokes contralateral pain, you should consider this dx
lumbar muscle strain
This is how to perform and interpret a FABER test
abduct hip, flex knee, place foot on opposite knee and apply pressure to knee. + if pain at hip or SI joint
This non-malignant etiology usually has an insidious onset and is often apparent on X-ray
Degenerative arthritis
Prolonged use of methylprednisolone for an autoimmune condition would make you more concerned for this etiology of LBP
vertebral fx
Three contraindications to using NSAIDs in LBP
Pregnancy post 20 weeks
CKD
PUDWhat is the "shopping cart sign" and what dx does it suggest?
leaning forward to decompress spine; Spinal stenosis
This is how to differentiate tight hamstrings from lumbar radiculopathy on supine straight leg raise test
if dorsiflexion provokes pain, indicates stretching of S5 or L1; if no pain, likely just tight hamstrings
one symptom associated with this finding, and its dx
worse with bending, +posterior thigh pain
spondylolisthesis
18yo p/w chronic morning stiffness and LBP, found to have CRP=70mg/L : most likely dx?
These are some best practices for prescribing opiates for LBP
-Try non-opiate tx first
-Rx short course
-Lowest dose possible
-If rx'ing an opiate co-formulated with acetaminophen (eg Tylenol w/ codeine), counsel on avoiding other acetaminophen-containing products
-Co-rx naloxone