LOWBACKPAIN2

LOW BACK PAIN : 

LOW BACK PAIN ANNA BOVEE SUSAN GRIGGS

Slide2: 

LOW BACK PAIN IS THE #1 MUSCULOSKELETAL COMPLAINT IN PCP. #2 COMPLAINT OVERALL

PREVALENCE: 

PREVALENCE 70% OF POPULATION WILL HAVE LOW BACK PAIN AT SOME POINT IN THEIR LIFETIME 90% OF THESE WILL HAVE AT LEAST ONE RECURRENCE

PREVALENCE: 

PREVALENCE MOST COMMON IN MEN IN YOUNG ADULT YEARS MOST COMMON IN WOMEN GREATER THAN 60 YEARS OF AGE

ANATOMY: 

ANATOMY THE BACK CONSISTS OF VERTEBRAE, APOPHYSEAL JOINTS STABILIZING LIGAMENTS PARASPINAL ABDOMINAL MUSCLES INTERVERTEBRAL DISCS

L3-L4 (2-12%): 

L3-L4 (2-12%) ROOT-L4 LATERAL AND ANTERIOR THIGH PAIN, MEDIAL CALF AND FOOT, GREAT TOE DECREASED SENSATION MEDIAL CALF AND FOOT, GREAT TOE MOTOR-QUADRICEPS DECREASED PATELLAR REFLEX

L4-L5 (30-40%): 

L4-L5 (30-40%) ROOT-L5 PAIN-LATERAL THIGH, ANT. CALF, DORSUM OF FOOT, GREAT TOE DECREASED SENSATION-ANT. CALF, MEDIAL FOOT, 1ST WEB SPACE, GREAT TOE MOTOR-DORSIFLEXION NO REFLEX DEFICIT

L5-S1 (45-55%): 

L5-S1 (45-55%) ROOT S1 PAIN-POST. THIGH, POST/LATERAL CALF, HEEL SENSORY DEFICIT-POST. CALF, LATERAL FOOT MOTOR DEFICIT-PLANTAR FLEXORS DECREASED ACHILLES REFLEX

CAUDA EQUINA(<1%): 

CAUDA EQUINA(<1%) MULTIPLE ROOTS PAIN-ANY OF THE ABOVE SENS-SADDLE ANESTHESIA, USU BILATERAL MOTOR-MULTIPLE, BOWEL OR BLADDER DYSFUNCTION REFLEXES-NO ANAL WINK, CREMASTERIC, ANY ALL ABOVE

MECHANICAL CAUSES OF LOW BACK PAIN: 

MECHANICAL CAUSES OF LOW BACK PAIN LIGAMENT STRAIN MUSCLE STRAIN/SPRAIN JOINT DISRUPTION/DEGENERATION INTERVERTEBRAL DISC DEGENERATION/ HERNIATION

MECHANICAL CAUSES OF LOW BACK PAIN: 

MECHANICAL CAUSES OF LOW BACK PAIN SPONDYLOLISTHESIS SPINAL STENOSIS DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS SCOLIOSIS/ KYPHOSCOLIOSIS

MECHANICAL CAUSES: 

MECHANICAL CAUSES VERTEBRAL EPIPHYSEAL ASEPTIC NECROSIS

INFECTIOUS CAUSES OF LOW BACK PAIN: 

INFECTIOUS CAUSES OF LOW BACK PAIN EPIDURAL ABSCESS VERTEBRAL OSTEOMYLITIS SEPTIC DISKITIS POTTS DISEASE

INFECTIOUS CAUSES: 

INFECTIOUS CAUSES ENDOCARDITIS INFLUENZA

NEOPLASTIC CAUSES OF LOW BACK PAIN: 

NEOPLASTIC CAUSES OF LOW BACK PAIN METASTASIS MYELOMA/LYMPHOMA EPIDURAL OR INTRADURAL TUMORS

METABOLIC CAUSES OF LOW BACK PAIN: 

METABOLIC CAUSES OF LOW BACK PAIN OSTEOPOROSIS OSTEOMALACIA HEMOCHROMATOSIS OCHRONOSIS

INFLAMMATORY/RHEUMATOID CAUSES OF LBP: 

INFLAMMATORY/RHEUMATOID CAUSES OF LBP ANKYLOSING SPONDYLITIS REACTIVE SPONDYLOARTHROPATHIES (REITER’S SYNDROME) PSORIATIC ARTHROPATHY POLYMYALGIA RHEUMATICA

REFERRED PAIN: 

REFERRED PAIN ABDOMINAL/RETROPERITONEAL VISCERAL PROCESS VASCULAR PROCESS MALIGNANCY HERPES ZOSTER

OTHER CAUSES: 

OTHER CAUSES PAGET’S DISEASE OF BONE FIBROMYALGIA PSYCHOGENIC PAIN MALINGERING

LUMBARSACRAL STRAIN: 

LUMBARSACRAL STRAIN MOST COMMON CAUSE OF LOW BACK PAIN-UNCLEAR ETIOLOGY USUALLY STRETCHING OR TEARING OF MUSCLES, TENDONS, LIGAMENTS, OR FASCIA RT TRAUMA CHRONIC MECHANICAL STRESS

LUMBARSACRAL STRAIN: 

LUMBARSACRAL STRAIN PAIN USUALLY STARTS 12-36 HOURS AFTER INJURY 70% ARE 20-40 YEARS OLD PAIN IN BACK, BUTT, THIGHS-AGGRAVATED BY STANDING, FLEXION-RELEIVED BY REST/RECLINING

PREDISPOSING FACTORS: 

PREDISPOSING FACTORS CHRONIC STRAIN OBESITY EXAGERATED LUMBAR LORDOSIS FORWARD TIPPED PELVIS WEAK PARASPINAL/ABDOMINAL MUSCLES/ POOR CONDITIONING LEG LENGTH DISCREPITANCY POOR POSTURE

TREATMENT: 

TREATMENT CONSERVATIVE-MOST RECOVER SPONTANEOUSLY WITHIN 4 WEEKS NSAIDS, MUSCLE RELAXERS (FLEXERIL/ROBAXIN), NARCOTICS IF ALLERGIC

TREATMENT: 

TREATMENT REASSURE/EDUCATE LIFESTYLE-STOP SMOKING, LOSE WEIGHT, POSTURE, FIRM MATTRESS, CHAIRS WITH LUMBAR SUPPORT

HERNIATED INTERVERTEBRAL DISC: 

HERNIATED INTERVERTEBRAL DISC TEARS IN ANNULUS FIBROSIS WHICH ALLOWS CONTENTS OF NUCLEUS PROPULSUS TO PROTRUDE PARAVERTEBRAL TENDERNESS, SPASM WITH SPLINTING IN AWKWARD POSITION

HERNIATED INTERVERTEBRAL DISC: 

HERNIATED INTERVERTEBRAL DISC ACUTE CAUSES SEVERE PAIN TRAUMA OR ANTECEDENT FLEXION/ STRAIN INJURY RELIEF WITH HIP FLEXION CENTRAL DISC-BIL WEAKNESS, BOWEL AND BLADDER DYSFUNCTION

HERNIATED DISC: 

HERNIATED DISC CHRONIC-DULL PAIN. USUALLY CONFINED TO LEG DECREASED DTR-TENDERNESS WITH STRAIGHT LEG RAISE-REFER TO ASSESSMENT BOOK IMPROVEMENT IN 6 WEEKS-MOST IN 6 MONTHS

RADICULAR PAIN: 

RADICULAR PAIN SHOOTING, SHARP, ELECTRIC PAIN WORSE WITH VALSALVA PARESTHESIA/NUMBNESS MAY OCCUR

HERNIATED-MRI: 

HERNIATED-MRI

SPINAL STENOSIS: 

SPINAL STENOSIS MIDDLE/OLDER ADULTS PAIN VARIES. WORSE IN DAY. AGGRAVATED-STANDING, EXTENSION ALLEIVIATED-REST. L4 ROOT-PSEUDO CLAUDICATION OSTEOARTHRITIS

SPONDYLOLISTHESES: 

SPONDYLOLISTHESES SPIPPAGE OF ONE VERTEBRAE OVER ANOTHER-USU. L5-S1 MC FEMALE ATHELETES ,26Y/O SPONDOLOLYSIS-BREAK OF PARS INTERARTICULARIS-OFTEN STRESS FRACTURE, HYPEREXTENSION. TIGHT HAMSTRINGS/ NO NEURO

KYPHOSIS/SCOLIOSIS: 

KYPHOSIS/SCOLIOSIS

KYPHOSIS: 

KYPHOSIS

NON MECHANICAL CAUSES LOW BACK PAIN: 

NON MECHANICAL CAUSES LOW BACK PAIN NEOPLASIA-MYELOMA/ METASTASIS/ TUMORS UNRELENTING PAIN AT REST WEIGHT LOSS AND WEAKNESS PREVIOUS MALIGNANCIES

INFECTION: 

INFECTION PAIN AT REST-TENDER SPINOUS PROCESS LEUKOCYTOSIS, INCREASED ESR, FEVER-BLOOD CULTURE H/O DM, IMMUNOCOMP., DRUG ABUSE, SYSTEMIC INFECTION, SURGERY

ANKYLOSING SPONDYLITIS: 

ANKYLOSING SPONDYLITIS SYMMETRIC SACROILITIS AND PROGRESSIVE INFLAMMATORY ARTHRITIS-HLAB27 INSIDUOUS ONSET-RELIEF WITH EXERCISE PAIN IN AM

ANKYLOSING SPONDYLITIS: 

ANKYLOSING SPONDYLITIS STIFF/ PAINFUL ANKYLOSED SACROILIAC JOINTS USU <40 Y/O-MALES DECREASED SPINAL MOBILITY/ CHEST WALL EXPANSION

OTHER RHEUMATOLOGIC CAUSES: 

OTHER RHEUMATOLOGIC CAUSES REACTIVE SPONDYLOSARTHROPATHIES (REITERS SYNDROME) PSORIATIC ARTHROPATHY POLYMYALGIA RHEUMATICA

REFERRED PAIN: 

REFERRED PAIN ABDOMINAL RETROPERITONEAL VASCULAR PROCESS HERPES ZOSTER

OTHER CAUSES: 

OTHER CAUSES PAGETS DISEASE FIBROMYALGIA PSYCHOGENIC PAIN MALINGERING

SCIATICA: 

SCIATICA PAIN ALONG LUMBAR OR SACRAL NERVE ROOT WITH OR WITHOUT NEUOSENSORY DEFICITS USU. HERNIATED DISC, CAN BE OTHERS

SCIATICA: 

SCIATICA

REFERENCES: 

REFERENCES Noble, J., Greene, H., Levinson, W., Modest, G., Mulrow, C., Scherger, J., et al. (Ed.). (2001). Textbook of primary care medicine (3rd ed.). St. Louis, MO: Mosby. (Original work published 1987) Seidel, H., Ball, J., Dains, J., & Benedict, G. (2006). Mosby's guide to Physical Examination (6th ed.). St. Louis, MO: Mosby Elsevier. (Original work published 1987) Uphold, C., & Graham, M. (2003). Clinical guidelines in family practice (4th ed.). Gainesville, Florida: Barmarrae Books. (Original work published 1993)