MSK 2 - LBP Red Flags

what sort of presentations warrant a "red light" (refer for medical management)

red flags, medical comorbidities that should be addressed before starting rehab, leg pain w/ progressive neurologic deficits

broad clinical concerns

fever

chills

sweat

unexplained weight loss

fatigue/malaise

unexplained/unremitting nausea and vomitting

night pain

inability to increase/decrease pain or symptoms

common pathologic fracture patient presentation

>70

female (but new research suggests males too)

prolonged corticosteroid use

mild/sudden trauma

unexplained pain

history of osteoporosis

sacral insufficiency w/ accompanied sign of the buttock

when is pain typically worse in people with pathologic fracture in LB

in weight bearing

what is the position of preference in LB fracture patients

supine

sacral stress fracture typical patient presentation

athletic female

increased vigorous/repetitive athletic activity

pain reproduced w/ athletic activity

pain in buttock

dietary insufficiency

menstrual irregularity

previous stress fracture

non responsive to other LBP treatment

sign of the buttock indicates ___

serious gluteal/low back pathology

sign of the buttock

limited trunk flexion in standing

limited and painful SLR but no numbness/tingling

hip flexion limited, more limited and painful with knee bent than SLR

hip rotation limited/painful in NON CAPSULAR pattern

empty end feel on hip flexion

what is spondylolysis

fracture of pars interarticularis

what is spondylolysthesis

fracture of pars with displacement/slippage of disc (often posterolateral)

typical spondylolysthesis/spondylolysis patient presentation

young individual

repeated hyperextension MOI

wrestlers, gymnasts, football linemen, etc

sudden bilateral sciatica with activity

pain with prone passive bilateral hip extension

no urinary/bowel incontinence

spinal compression fracture typical patient presentation

history of major trauma (MVA, fall from height, blow to spine)

OR

history of minor trauma (osteporosis, elderly, heavy lift, fall)

>75 y/o

prolonged corticosteroid use

things that increase suspicion of spinal compression fracture

increased pain in WB, point tenderness at fracture site

abdominal aortic aneurysm (AAA) typical patient presentation

abdominal, back, or groin pain

pain at rest/night

pain increases with activity, especially LE

pulsating mass

throbbing pain

family history of CVD and/or AAA

presence of PVD or CAD and associated risk factors

symptoms not provoked w/ mechanical exam of low back

vascular claudication typical patient presentation

elderly

family history of CVD

pain in calf with activity, relieved with rest

one foot colder than other

symptoms not reproduced with mechanical exam

positive incline treadmill test

how does the incline treadmill test help differentiate between vascular and neurogenic claudication

patients tend to adopt flexed position --> pain would improve if its neurogenic and stay the same if its vascular

what posture is a common neurogenic pain sign

shopping cart

kidney stones typical patient presentation

sudden, intermittent, sharp pain in testicles/labium

fever

renal infection

symptoms not reproduced with mechanical exam of low back

red flag GI issues typical presentation

pain in upper lumbar (L1-2) area after eating

pain relieved by further intake of food

symptoms not reproduced with mechanical exam

chronic, progressive symptoms

associated abdominal pain

ankylosing spondylitis typical patient presentation

middle aged

pain on/off regardless of exertion

progressive ROM loss

alternating SIJ pain with walking

vertical pain radiation, not lateral or to LE

stiffness in AM, eases with movement

no paresthesia

inflammation of eye, worsens w/ bright light exposure

later: grossly limited side bending (bilaterally)

cauda equina typical patient presentation

URINARY RETENTION IS SYMPTOM OF REFERENCE

saddle pain/parasthesia

bilateral severe weakness/pain in LE

what most commonly causes cauda equina

atraumatic midline posterior disc herniation at L3-S1

cancer (spinal tumor) typical patient presentation

PMHX of cancer

>50 w/ new onset of LBP

unexplained weight loss

night pain

worsening pain

no response to conservative management

sign of the buttock

PB KTLL

what does PB KTLL stand for? what is its significance

prostate, breast, kidney, thyroid, lung, lymphoma

cancers that frequently cause LBP

infection common patient presentation

fever, malaise, swelling

recent bacterial infection

recent lumbar spine surgery

immunocompromised

night pain

worsening pain

not responsive to conservative management

intravenous drug use/abuse

rigid spine, limited accessory mobility

central sensitization typical patient presentation

PMHX of back pain and inability to heal

widespread pain

pain doesn't follow anatomical pattern

high psychological distress

pain disproportionate to provocation and easing tests

hypersensitivity to light touch