Post on 03-Jan-2016
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BACKACHE IN ADOLESCENCE BLOCK 14
WHAT’S SPECIAL
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
• Mechanical• Pathological
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
TREATMENT
Clinical assessment
• History• Examination• Investigations
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
Examination of the back
• Deformity• Gibbus• Tenderness• Movement/ stiffness
Red Flags
• Any neurologic deficit -saddle numbness -urinary incontinence -urinary retention
• Radicular pain • Stiff back
TREATMENT
• Disease specific
Infection - Acute discitis - Tuberculosis
Tumours - osteoid osteoma
Trauma - spondylolysis
Scheurmann’s diseases
Causes in adolescence
• Pathology• Clinical examination• Investigation• Treatment
Backache in children should always be regarded
as pathological