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