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21 Cards in this Set
- Front
- Back
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What is the 2nd most common reason for absenteeism in the workplace?
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back pain
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If off work 6 mo, ReturnToWork in ...%
If off work 1 year, RTW ...% If off work 2 years, RTW ...% |
50
25 0 |
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Clinical course:
-About 10% of LBP patients continue with residual complaints (don’t get better) -This group is the ... most common reason for primary care office visits -Proper treatment depends on accurate diagnosis (tough due to complex structures), possible diagnostic tests, and COMPLETE .... -Assess for .... |
2nd
HISTORY AND PHYSICAL RED FLAGS |
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Questions I should ask:
-How long have you had LBP? -Where is the pain/numbness? -What makes it worse? (coughing, sitting, valsalva, think of ...) -Do you have weakness? -Do you have incontinence or retention of bowel or bladder? -What were you doing before symptoms started? Trauma? -Are symptoms worse when laying down? (Suggestive of ...) |
herniated disc
cancer |
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General health questions:
-IMMEDIATE WORK UP IF ANY “YES”: -Age over 50? -History of fever or weight loss? -History of cancer? -Symptoms of ...? (trouble starting/stopping stream in men) -Any swollen lymph nodes? -Current history of steroid use? -History of osteoporosis? -Other medical issues ( Conn.Tiss.Dz, abd. Pain) |
prostatism
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QUESTIONS FOR NEUROCLAUDICATION OR SPINAL STENOSIS:
How far can you walk? - if < ... meters, may be disabling enough to consider aggressive work/up Why do you stop walking? -should be pain below gluteal fold What relieves the pain? - ... should give relief (if spinal stenosis) |
300
flexion |
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Seronegative spondyloarthropathies are more common in ..., have an .. onset, have pain lasting more than 3 months, have morning stiffness, and pain gets ... with exercise.
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males
insidious better |
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Nerve roots to focus on for physical exam:
L4= ... reflex, ..., quads, hip adductors, (sensory to) ... ant. shin L5= no good MSR; ..., hip abductors, ant. Tib. (a little), hamstring, (sensory) ... foot sensation S1= ... reflex, gastroc/soleus, glut. Max., sens. (sensory) To .... foot |
knee
ant.tib medial ext. hallucis middle ankle lat |
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special studies:
-... imaging if significant trauma, neurologic deficit, fever, weight loss, systemic disease, hx. Of cancer, age >50 or <20, AnkylosingSpondylitis, steroid use hx., litigation -After 3-4 weeks, exceeding natural history: xrays, ESR, consider bone scan, MRI of possible surgery. -After that, consider SBC,BMP,UA,RF,ANA, etc. |
Early
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The best X-ray view to get for low back pain is ... postural ... and lateral flexion and extension
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Standing
AP |
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According to a certain study, what allele presence increased risk of Lumbar Disk disease by 3-fold, and has shown that it alters the mechanical properties of collagen?
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Trp3
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Red Flags of Back pain:
-... changes/UMN changes -Bowel/Bladder/Sexual dysfunction -... Pain or no relief with bed rest -... Loss -Fever/Chills -Over ... month of pain with treatment |
Gait
Night Weight 1 |
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Red flags:
think CANCER -age over ... -Prior history of ... -Unexplained ... loss -Over ... month of pain with treatment -No relief with ... -Fever |
50
cancer weight 1 bed rest |
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Red flags:
think Osteomyelitis: -... (ask about this) -UTI -Skin or other ... -Open wound -Immunocompromise -Fever |
IVDrugAbuse
infection |
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RED flag:
think SPINAL STENOSIS: -Age over ... -Pseudoclaudication -Pain with ... of their back |
50
extension |
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Red flag:
think Ankylosing Spondylitis -Onset under age ... -Pain not relieved in ... postion -... stiffness relieved with exercise -Pain duration over ... months |
40
supine AM 3 |
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Pediatric back pain has its greatest incidence in ... at time of greatest growth spurt
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puberty
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are these pediatric back pain risk factors?
-Overweight -Hamstring tightness -Low level physical activity -Poor school performance -Back pack use -issues here re: metabolic demand needed |
NO
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Pediatric Back tumors:
-Most common malignant lesion: ... -Common ... lesions: osteoid osteoma, osteoblastoma, bone cysts. |
Ewing Sarcoma
benign |
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Scheuermann’s Disease:
-Etiology:unknown -Adolescence -... exaggerated thoracic kyphosis -Presents with thoracic kyphosis and compensatory lumbar lordosis Radiography: -ant. Wedging of at least 3 adjacent vertebrae -end plate irregularity -disc space narrowing |
PAINLESS
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-Back pain is a common, expensive, and disabling problem in America.
-Back pain involves very complex structures and merits careful, organized evaluation -Back pain usually gets better. -Use imaging judiciously -Consider a multifaceted approach to evaluation of back pain including medication, OMT, exercise, education, job and psychological factors. *The single most common risk factor that determines if someone goes back to work with LBP is ... -Back pain in children is not rare and has many causes. |
job satisfaction
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