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