Lower back pain differential diagnosis – Flashcards
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Second most frequent reason for visits to a physician
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back pain
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Risk factors for accelerated degenerative disk disease
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Genetics Obesity Smoking
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Cauda equina Syndrome
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Saddle anesthesia, b&b changes; incontinence, recent onset erectile dysfunction. neurologic disorder involving lumbosacral nerve roots; trauma, tumors, spondylolisthesis, large disk herniation. Rectal exam to assess for loss of rectal tone. Surgical referral recommended
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axial causes of back pain
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1) degenerative disk disease 2) Facet arthropathy 3) sacroiliac joint dysfunction 4)Lumbar or sacral fractures
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spinal stenosis
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thigh, calf, and back pain that worsens with standing/walking alleviated by sitting or flexing forward "Shopping cart sign"
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Seronegative spondyloarthropathies
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usually in younger; pain, stiffness, reduced ROM in a.m that improves with activity. Pain worse in supine position worsens at night
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Antalgia
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walk with a limp, favors one side more than the other. Observe skin of lower extrem to assess for vascular insufficiency
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Straight leg raise test
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pt supine, examiner raises leg to 70-90 degrees; if pain produced between 20-70 positive result. If unaffected leg exhibits same results indicates a large disk herniation.
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Femoral nerve stretch test
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root tension sign. Looks for upper lumbar radiculopathy in L2-4. Pt prone, leg flexed at knee and bent toward thigh with hip extension. Positive result if pain reproduced in anterior thigh as knee is flexed forward. Possible sciatica
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diabetic amytrophy
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It usually involves weakness followed by wasting of muscles, and excruciating pain in the muscles of the thigh, hip, and buttocks. The typical symptoms are fairly sudden onset and usually occur on one side of the body but may involve both sides. Heals with time with blood glucose control, pain meds for comfort.
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Vascular claudication
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produces a cramping pain in the buttocks, thighs, or calves caused by impaired blood flow to the legs due to atherosclerosis. Commonly mistaken for spinal stenosis
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IBD can cause two types of joint pain
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Arthralgia is common among patients with IBD occurring in 40-50% of patients and is pain without inflammation while Arthritis is pain with inflammation
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Diplopia
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double vision
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Lyme disease symptoms
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diplopia, facial pain or numbness, vertigo, or hearing changes. headache, fatigue, fever, myalgia, neck stiffness, nausea, vomiting, arthralgia, photophobia, and arthritis.
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erythema migrans
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tick bite with lymes disease innoculation that results in 15 cm or larger lesion in 50% or more cases
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Banwarth's syndrome
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triad of neurological complaints comprised of lymphocytic meningitis, cranial, and peripheral neuropathies, and radiculopathies commonly caused by lymes disease.
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"Red flags" for back pain
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history of constitutional symptoms, weight loss, nocturnal exacerbation of pain, and prior history of malignant disease.
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Ankylosing spondylitis
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Occurs usually between adolescents or early 20's but almost always before 40. form of arthritis that primarily affects the spine, although other joints can become involved. It causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort and can lead to thoracic kyphosis and restrictive lung disease.
