backache block 14
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BACKACHE BLOCK 14
2012
BACKPAIN
Prof. Mthunzi NgcelwaneHoD: Orthopaedics
Other names
• Lumbago• Acute backstrain• Chronic backache• Myalgia• Fibrocytis• Myofacial syndrome
Extent of the problem (Nachemson)
• Affects 80% of people• Self – limiting disease• 70% clears spontaneously in 2-3 weeks• 90% clears with conservative treatment in 6-8
weeks• <5% will need surgery
Causes of low backpain • Trauma - fractures(esp. pathological) - sprains• Infections –acute discitis - tuberculosis• Tumours -primary( myeloma) -secondary(breast , lung , thyroid , renal, prostate) • Degeneration -oa of the 3-joint complex -disc herniation• Refered from abdomen - pancreas ,kidneys ,aorta , uterus• Psychosocial factors
SPONDYLOLYSTHESIS
Disc Herniation
Walking with difficulty:1. Standing posture tilted2. Movements of back greatly limited3. Local tenderness4. Local muscle spasm
Disc degeneration Chronic low backache
Myelomatosis
METASTASESMETASTASES
Facet Syndrome
Spinal Stenosis:
1. Claudication pain2. Slight forward bending and rest
improves symptoms3. 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 <15; >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
Always examine the abdomen
In most cases cause of backpain not seen on back exam
Examination of the back
• Deformity• Gibbus• Tenderness• Movement/ stiffness
Neurologic examination
• Signs of sciatic nerve irritation -SLR -Bowstring test • Nerve root entrapment • Cauda equina
Straight leg raising test:
70°
50°
20°
Nerve fall-out: 1. Reflexes2. Muscle power3. Sensation4. Sphincters
Investigations
• ESR/CRP• FBC• xr
Treatment
• Anaelgesics/nsaids• Bed rest , less than 3 days• Traction?• Muscle relaxants – valium• Physiotherapy• Psychologic support
rehabilitation
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