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Describe the organization of the regional back pain scheme
- Cervical, thoracic, lumbar/sacral
- Acute or chronic
- Infections, neurologic, musculoskeletal, vascular
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What is the medical term for neck pain?
Cervicalgia
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What is the medical term for low back pain?
Lumbago
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What is the most common MSK complaint in primary care?
Lumbago (low back pain)
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In the cervical spine, how is pain classified as either acute or chronic?
- Acute: less than 6 weeks
- Chronic: more than 6 weeks
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In the thoracic spine, how is pain classified as either acute or chronic?
- Acute: less than 4/6 weeks
- Subacute: 4/6 weeks – 12 weeks
- Chronic: more than 12 weeks
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In the lumbar spine, how is pain classified as either acute or chronic?
- Acute: less than 4/6 weeks
- Subacute: 4/6 weeks – 12 weeks
- Chronic: more than 12 weeks
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What are the red flags in the history for back pain? (7)
- Duration
- Age of patient
- Trauma
- Cancer
- Fever and chills
- Weight loss
- Pain even when supine
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What are the components of a physical exam to evaluate neck and pack pain?
- HEENT
- Cardio
- Lungs
- Abdomen
- Neck and Back MSK
- Neurologic
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What are the components of a neurologic exam?
- Sensory
- Reflexes
- Strength
- Special tests
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What does the straight leg raise test evaluate? What does a positive straight leg raise indicate?
- Radicular pain
- Lumbar or sacral nerve irritation
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What does a positive opposite crossed straight leg raise indicate?
Lumbar disc herniation
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What are the red flags on physical exam for back pain? (5)
- Fever
- Incontinence
- Anal sphincter laxity
- Positive straight leg test
- Major motor weakness
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What are the red flags for neck/back pain that indicate infection? (4)
- Fever and chills
- Night sweats
- Pain despite analgesics
- Recent bacterial infection
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What are the red flags for neck/back pain that indicate a neurologic component? (4)
- Trauma
- Incontinence
- Decreased anal sphincter tone
- Major motor weakness
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What are the red flags for neck/back pain that indicate cancer? (4)
- Above 50
- Chronic pain
- Night sweats
- Pain despite analgesics
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Describe the recommendations for imaging for chronic neck pain
Five-view X ray, if normal no further imaging, if abnormal, MRI follow up
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Describe the recommendations for imaging for acute low back pain
Not indicated, unless you suspect patient has a serious underlying condition
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What is spondylosis?
Arthritis of the spine (disc space narrowing)
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What is spondylitis?
Arthritis of spine from an inflammatory cause
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What is spondylolisthesis?
Anterior displacement of a vertebra on the one beneath it
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What is spondylolysis?
A fracture in the pars interarticularis where vertebral body and the posterior elements protecting the nerves are joined
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What is spinal stenosis?
Narrowing of central spinal canal
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What is radiculopathy?
Impairment of a nerve root
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What is cauda equina syndrome?
Abnormal pressure on bottom of spinal canal resulting in incontinence
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