Back pain SOCRATES Associated features: Falls Fever Leg pain Sensory changes Weakness Weight loss Night sweats Back pain stiffness Sensory changes Spine tenderness Urinary symptoms Altered bowel habits Medications Prescribed Non-prescribed Tests and procedures -> cancer screening, investigations Past medical history Malignancy Past medical history MSK history Past surgical history Family history Social history: Diet Exercise Alcohol history Smoking history Recreational history Differentials Cauda equina syndrome: Fever Leg pain Weakness Weight loss Night sweats Back stiffness Sensory changes Spine tenderness Urinary symptoms Altered bowel habits Lumbosacral radiculopathy: Leg pain Weakness Back stiffness Sensory changes Urinary symptoms Altered bowel habits Back stiffness Lumbar disc herniation Mostly similar questions to above OA: Weakness Back stiffness Arthralgia: knees, hips, IP joints, CMC and first MTP One or more joints Variable severity Insidious onset Worse at night, worse after lots of use. Joint stiffness: Short periods and relate to inactivity Osteophytes, capsular thickening, synovial hyperplasia and joint effusions -> limit joint movement Injury Lumbar sacral stenosis: Leg pain Weakness Sensory changes Urinary symptoms Altered bowel habits Lowe back malignancy: Fever Leg pain Weakness Weight loss Sensory changes Urinary symptoms Altered bowel habits Epidural abscess Fever Leg pain Weakness Sensory changes Spine tenderness Urinary symptoms Altered bowel habits Lumbar muscular stain Spasms Family history Manage by heat packs Vertebral compression Loss of height Fatigue Weight loss Night sweats Spine tenderness Fever Ankylosing spondylitis: Spondylitis Intense sharp pain. Aching quality and may be sharp. Onset usually before 40. Relieved by physical activity. Rest does NOT relieve pain Duration for at least 3 months. Progression to stiffness Itchy eyes and other systemic symptoms such as rashes Stiff back Reduced range of motion Difficulty breathing Poor posture Sacroiliitis Pain and stiffness in the buttock Pain may radiate to the thigh. Alternation L/R is common. Extra-axial arthritis Less commonly occurs Help pain typically on one side Hip and shoulder pain Extra-articular features Unilateral burning eye pain Photophobia Increased lacrimation Anterior uveitis -> occurs in 30% of patients.