Back pain 2

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Back pain 2
2012-07-15 20:15:53
Additional Back Pain Exam

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  1. Modified straight leg test results
    Pt sitting, raise leg to straight from 90degrees

    • If no pain: functional problem  
    • If pain: see "tripod sign" = structural problem 
  2. CVA tenderness
  3. Straight leg test
    • Pt supine, Raise leg 80 degrees
    • If <80degrees, lower slightly, if can dorsiflex=hamstrings tight
    • If <80degrees and cannot dorsiflex= sciatica   
    • Pain radiating down post/lat thigh and past knee=herniated disk impinging L5/S1
    • Pain in opp leg in SLT= central disk herniation 
    • If pain before 30degrees=malingering
  4. Crossed Straight leg test
    • Asx leg raised with Sx leg crossed over it
    • Pain in Sx leg is diagnostic of central disk herniation
    • no pain does no rule out (.25 sens, .90 spec)  
  5. FABER test
    • Flex knee, abduct hip, and externally rotate thigh
    •  (place affected foot on opp knee) and press down on tested knee while stabilizing opp hip. 
    • Pain or cannot lower to parralel =sacroilitis or hip joint path
  6. Pelvic compression test
    Pain = sacroilitis
  7. Classic disk herniation sx
    • Pain worse with sitting or bending
    • inc pain with coughing or sneezing
    • pain radiating down leg or foot
    • paresthesia
    • muscle weakness (foot drop)      

  8. back pain + urinary retention
    Cauda equina syndrome
  9. Back pain cancer red flags
    • Hx cancer 
    • Unexplained weight loss >10 kg within 6 months 
    •  >50 years old or <17 years old
    • Failure to improve with therapy 
    • Pain persists for more than 4 to 6 weeks 
    • Night pain or pain at rest
  10. Back pain infection red flags
    • Persistent fever (temperature over 100.4 F)
    • Hx IV drug abuse 
    • Recent bacterial infection, esp bacteremia (UTI, cellulitis, pneumonia)
    • Immunocompromised
  11. back pain cauda equina syndrome red flag
    • Urinary incontinence or retention
    • Saddle anesthesia
    • Anal sphincter tone decreased or fecal incontinence     Bilateral lower extremity weakness or numbness Progressive neurologic deficits
  12. Back pain significant herniated nucleus pulposis red flags
    • Major muscle weakness (strength 3 of 5 or less) 
    • Foot drop
  13. back pain vertebral fracture red flags
    • Prolonged use of corticosteroids
    • Mild trauma over age 50 years
    • Age greater than 70 years
    • Hx osteoporosis
    • Recent significant trauma at any age 
    • Previous vertebral fracture
  14. Tx for back pain without redflags
    • NSAIDS
    • muscle relaxant
    • continue activity level as tolerated, avoid strenuous activity
    • moist heat
    • PT can help
    • revisit in 4-6 weeks if not improving