Term
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Definition
central canal or neuroforaminal stenosis
pain with lying or standing straight
pain can be diffuse, spread down the legs |
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Term
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Definition
back pain that radiates below the knee
positive EMG, but don't rule out if negative (pt might not be destroying axons)
epidural steroid injections are helpful and allow pts to avoid surgery
neuropathic pain meds for acute problems, then other tx (intrinsic and extrinsic)
surgery: pain for 3-6 months, progressive motor deficit, cauda equina syndrome |
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Term
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Definition
rare - radiating pain that stays above knee
loss of the patellar reflex
leg pain when raised lying on stomach |
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Term
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Definition
pain when straight leg raised, radiates below knee
weak dorsiflextion (4,5) and patellar reflex (3,4) |
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Term
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Definition
pain down the back thigh
difficult to walk on heels - weak dorsiflexion
altered sensation on dorsal foot
reduced internal hamstring reflex |
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Term
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Definition
cannot do one-sided to raises
loss of Achilles reflex - asses with plantar strike technique |
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Term
| S2, S3, S4 radic (cauda equina syndrome) |
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Definition
numbness and weakness around genitals and anus
central disc squishes entire cauda equina - ruptured through posterior longitudinal ligament
surgical emergency |
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Term
|
Definition
pain does not radiate below knee, eased with flexion
feels good to sit
improvement with targeted steroid injection
tx - lose gut, stretch hip flexors |
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Term
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Definition
always get back pain in pt over 50
worse if pt is awoken at night
clue is if pain is in thoracic spine
history of cancer?
maybe not prolong life, but prevent paralysis and relieve symptoms |
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Term
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Definition
diagnose with SPECT followed by standard CT
minimum 3 months to heal for fractures |
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Term
| pars interarticularis stress fx |
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Definition
pain reproduced with arching standing on one foot
common in young athletes
xrays unreliable, bone scan diagnostic
"doggie gets a collar"
brace and minimal activity for 3-6 mo
risk of spondylolithesis |
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Term
|
Definition
common in tall males
sudden pain after bending or lifting, or gradual during a trip
weeks to months to heal on their own
worse if patient smokes |
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Term
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Definition
focal tenderness in sacral sulcus and reproduction of pain with: FABER, resisted hip abduction, passive reverse straight leg raising (pt supine, knee at 90 deg)
pain radiates to low back/upper out quadrant of buttock, groin, posterior thigh and leg
PT benefit, injections |
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Term
|
Definition
abuse, domestic violence
emphasize function over pain relief |
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Term
| vertebral osteomyelitis/discitis |
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Definition
localized neck or back pain - 15% present exclusively with radicular sx
constitutional sx common, but not necessary
recent history of pneumonia, UTI, or simple cellulitis
dx - plain film then CT/MRI, sedimentation rate
common in immunocomp pts |
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Term
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Definition
most with severe pain near spine and fever
1/5 present exclusively with radicular symptoms
with time - sphincter dysfunction, bilat LE pain and weakness, progression to paraparesis and paraplegia
inc WBC and ESR
MRI with contrast
tx - emergent laminectomy and long term antibiotics |
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