BACKACHE BLOCK 14
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Transcript of BACKACHE BLOCK 14
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BACKACHE BLOCK 14
2012
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BACKPAIN
Prof. Mthunzi NgcelwaneHoD: Orthopaedics
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Other names
• Lumbago• Acute backstrain• Chronic backache• Myalgia• Fibrocytis• Myofacial syndrome
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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
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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
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SPONDYLOLYSTHESIS
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Disc Herniation
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Walking with difficulty:1. Standing posture tilted2. Movements of back greatly limited3. Local tenderness4. Local muscle spasm
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Disc degeneration Chronic low backache
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Myelomatosis
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METASTASESMETASTASES
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Facet Syndrome
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Spinal Stenosis:
1. Claudication pain2. Slight forward bending and rest
improves symptoms3. Changing neurological picture:
positive signs after walking, e.g.
power & reflexes ↓
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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.
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Clinical assessment
• History• Examination• Investigations
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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
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Red Flags
• Age <15; >50• Duration >1mnth• History of cancer• Loss of weight• Rest pain• Night pain• Fever• Morning stiffness
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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
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Always examine the abdomen
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In most cases cause of backpain not seen on back exam
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Examination of the back
• Deformity• Gibbus• Tenderness• Movement/ stiffness
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Neurologic examination
• Signs of sciatic nerve irritation -SLR -Bowstring test • Nerve root entrapment • Cauda equina
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Straight leg raising test:
70°
50°
20°
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Nerve fall-out: 1. Reflexes2. Muscle power3. Sensation4. Sphincters
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Investigations
• ESR/CRP• FBC• xr
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Treatment
• Anaelgesics/nsaids• Bed rest , less than 3 days• Traction?• Muscle relaxants – valium• Physiotherapy• Psychologic support
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rehabilitation
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