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What are the primary goals of managing back pain in primary care?
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To provide evidence-based care, reduce unnecessary imaging, and decrease unnecessary specialty referrals for nonspecific back pain.
What exam finding would suggest a need for immediate imaging in a back pain evaluation?
Neurologic symptoms such as foot drop, unilateral motor weakness, loss of sensation, or abnormal reflexes.
What is assessed during the Deep Tendon Reflex exam in the context of back pain evaluation?
Reflexes associated with the L4 to S1 nerve roots through knee and ankle reflex testing.
During a sensory exam, what does numbness over the dorsum of the foot suggest?
Possible involvement of the L5 nerve root.
What is the significance of a positive straight leg raise test during a back pain examination?
It may indicate nerve root irritation or compression, often associated with herniated discs or lumbar radiculopathy.
What examiner techniques are used to evaluate the motor abilities associated with the L4 to S1 nerve roots?
Knee extension, dorsiflexion of the big toe, and foot plantar flexion.
What does decreased reflex response in the ankle suggest in a back pain examination?
It may suggest issues with the S1 nerve root.
Why is a thorough patient history combined with a physical exam crucial for back pain assessment?
It aids in clinical decision-making and helps identify whether further imaging is necessary, based on the presence of neurologic symptoms.
In a back pain evaluation, what is the importance of assessing a patient's ability to walk on their heels?
It assesses for unilateral foot drop, which can be indicative of nerve root pathology.
What are the three main categories of back pain patients in a primary care setting?
1. Patients with serious causes needing urgent referral and imaging. 2. Patients with possible herniated discs/spinal stenosis. 3. Patients suitable for conservative therapy with likely nonspecific back pain.
What could be inferred from negative results in all physical exam tests but persistent pain in back pain management?
The patient might have nonspecific back pain, which often does not correlate with observable physical exam findings.
What is indicated by numbness over the medial malleolus in a sensory exam?
It indicates a possible pathology involving the L4 nerve root.
Which physical exam technique involves checking for spinal tenderness, warmth, and muscle spasms?
Palpation.
Describe the significance of unilateral foot drop during a physical examination for back pain.
Unilateral foot drop may suggest nerve root compression and could be a key identifier for imaging decisions.
Which patients are unlikely to require immediate imaging based on their back pain presentation?
Patients under 50 without red flags, pain primarily in the back, and no radiculopathy signs likely have nonspecific back pain.
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