Spinal Stenosis: 1.Claudication pain 2.Slight forward bending and rest improves symptoms 3.Changing neurological picture: positive signs after walking, e.g. power & reflexes ↓
4. Can climb stairs due to slight forward bending position of spine, which relieves pressure on artery supplying nerve root. Arterio-sclerosis patient cannot! 5. Treatment: Usually conservative.
Clinical assessment History Examination Investigations
History When did the pain start What caused it Nature of pain Does it radiate What makes it worse/better Do you feel it at rest Does cough/sneezing make it worse Previous treatment Does it interfere with :home.work.play What work do you do
Red Flags Age 50 Duration >1mnth History of cancer Loss of weight Rest pain Night pain Fever Morning stiffness
examination Watch patient walk Note ease of getting onto exam table Assess abdomen Is tenderness ellicited in abd same as the pain patient presents with Examine the hips Neurologic examination Examination of the back