Back Pain

Back Pain Question and Answers

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A 15-year-old female elite gymnast with low back discomfort who began experiencing symptoms slowly over the past few weeks arrives at your clinic. She disputes any recent wounds.

You observe that she has a hyperlordotic posture during a physical examination. Her hamstrings are so tight that she can't touch her toes. Her single-leg extension test was successful. Spondylolysis is the diagnosis you offer her.

Which of the ensuing assertions concerning spondylolysis is true?

Correct! Wrong!

Explanation:
In the general population, spondylolysis is a very uncommon cause of low back pain, although it is more frequent in athletes. Degeneration of the pars interarticularis, typically at the L4-L5 vertebral contact, is how the condition manifests.

Spondylolysis is not present at birth, but it can appear at a young age in athletes—gymnasts, football linemen, weightlifters, and dancers, especially those who perform ballet—who hyperextend their low backs as part of their sport. These athletes display tight hamstrings and a hyperlordotic stance. When the athlete tries single-leg hyperextension, pain is made worse.

A 55-year-old woman arrives at your office and claims that she has been experiencing low back discomfort for three days as a result of falling on the ice.

During her physical examination, the lumbar paravertebral muscles on both sides of her show soft tissue soreness and spasm. Her deep tendon reflexes and lower extremity exams are both within normal ranges.

Which of the following treatments for her injuries would be an acceptable first-line pharmacologic management?

Correct! Wrong!

Explanation:
NSAIDs are used as the first line of treatment for persistent low back pain, followed by tramadol or duloxetine as the second line of treatment. Opioids should only be used after a full risk-benefit discussion with the patient in cases of chronic low back pain that is unresponsive to first- or second-line therapy.

Although oral steroid medication is occasionally used to treat the symptoms of radicular pain, there is no proof that it is effective in treating low back pain.

When passively extending the quadriceps while the client is lying on the ground, severe low back pain indicates an issue with the:

Correct! Wrong!

Explanation:
Sciatica symptoms are brought on by pressure on the sciatic nerve, which is caused by nerve compression at L3, L4, and L5. Lower back pain that shoots down to the buttocks, thigh, and legs is possible.

After falling from a ladder at work the day before, a 50-year-old house painter shows up to your office. He claims that as the top of a 10-foot ladder started to slide towards the wall, he jumped off and came to rest on his feet. Despite taking ibuprofen and using a heating pad, he experienced rapid onset mid-back pain that is still present today. He claims that no pain is traveling to his legs.

Upon physical examination, you discover point soreness at the level of T10 with intact neurologic function both at and below that level. A compression fracture of the T10 vertebral body is seen on the plain films that you ordered.

Regarding the treatment of this injury, which of the following assertions is true?

Correct! Wrong!

Explanation:
This patient's traumatic compression fracture has a well-described mechanism. The anterior column of the spine is typically affected by these fractures, which are brought on by high-energy trauma like falling off a ladder. Despite the fact that compression fractures are typically thought to be stable, rotation on plain film shows that the fracture is unstable, necessitating a consultation with an orthopedic or neurosurgery specialist. The aim of treatment for traumatic stress fractures is to rule out and avoid neurologic damage.

A 25-year-old man who has been employed to work at a nearby lumber supply company comes to your clinic for a physical. He is anxious despite being thrilled about his new employment choice because some of his buddies have suffered back ailments while working at the business. What can he do to prevent harm to his back, he enquires.

Which of the following suggestions may you provide him based on the US Preventive Services Task Force's (USPSTF) recommendations?

Correct! Wrong!

Explanation:
It is helpful to understand the USPSTF recommendations addressing primary and secondary prevention of back injuries because low back pain is a problem that primary care doctors frequently encounter.

The adoption of healthy lifestyle practices, such as frequent exercise and quitting smoking, is likely helpful in enhancing all patients' general health, even when it isn't always advantageous to prevent injury.

What is the most likely source of pain on the left side of the genitalia when side-flexing to the right?

Correct! Wrong!

Explanation:
Lower back and upper buttock pain are brought on by iliolumbar ligament sprains. Commonly, one side of the spine and deep in the back are where the pain is felt. Your pain might get worse if you bend, arch, or twist your back.

Which nerve root or roots are responsible if the psoas is weak when tested?

Correct! Wrong!

Explanation:
The L2-L3 disc region is the source of the second lumbar nerve, which supplies the front of the thigh and the shin of the femur among other parts of the lower limb. It provides supply to the Quadratus Lumborum and Iliopsoas muscles, which are located in the upper region of the lower back.

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