Nivetha C

APPROACH TO PATIENT WITH BACK PAIN

It is an extremely common problem, afflicting the human race across the globe cutting the geographical boundaries, race, culture, etc.

• 80% of persons in modern industrial society will experience back pain at some time during their life.

LOW BACK PAIN

CAUSES

Congenital Traumatic Inflammatory Degenerative

Neoplastic Metabolic From viscera Miscellaneous

• Age: <20 years: Spondylolysis 20-40 years: Disk Herniation >40 years: Spondylosis, Lumbar canal stenosisCommon to all age groups: Ligament sprain, muscle strain.

• Sex: Females- pregnancy, osteoporosis, rheumatoid arthritis Males- ankylosing spondylitis, trauma

HISTORY

• Occupation: people with sedentary jobs and heavy manual labourers.

• Past history: h/o spinal disease h/o trauma h/o inflammatory disease

HISTORY

• Location

• Onset

• Localisation of Pain

• Progression of the pain

• Relieving and aggravating factors

FEATURES OF PAIN

• It is defined as radiating pain along the course of the sciatic nerve and is felt in the back, buttocks, posterior of the thighs, legs and the foot.

• It is commonly due to disk prolapse.• Broadly, sciatica can either be because of

inflammation of the sciatic nerve or because of compression of one of the roots constituting the sciatic nerve.

SCIATICA

• Stiffness

• Pain in other joints

• Neurological symptoms

• Extra-skeletal symptoms

• Mental status

ASSOCIATED SYMPTOMS

• Position

• Spasm

• Tenderness

• Swelling

• Range of movement

PHYSICAL EXAMINATION

Lying down position:• SLRT• Neurological examination• Peripheral pulses• Adjacent joint• Abdominal, rectal or per vaginal examination

PHYSICAL EXAMINATION

• Blood tests

• Radiology

• CT scan

• MRI scan

INVESTIGATIONS

• Treatment of underlying cause

• NSAIDS, muscle relaxants, physiotherapy, traction, use of belts and corsets.

• Proper positional habits, back exercises and back education helps in prevention of back pain.

TREATMENT

Low back pain

Acute

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