Comprehensive Overview of Backache and Low Back Pain Management

1. BACKACHE BLOCK 14 2012

2. BACKPAIN Prof. Mthunzi Ngcelwane HoD: Orthopaedics

3. Other names • Lumbago • Acute backstrain • Chronic backache • Myalgia • Fibrocytis • Myofacial syndrome

4. 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

6. 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

8. SPONDYLOLYSTHESIS

9. Disc Herniation

13. Walking with difficulty: 1. Standing posture tilted Movements of back greatly limited Local tenderness Local muscle spasm

15. Disc degeneration Chronic low backache

17. Myelomatosis

19. METASTASES METASTASES

21. Facet Syndrome

25. Spinal Stenosis: Claudication pain Slight forward bending and rest improves symptoms Changing neurological picture: positive signs after walking, e.g. power & reflexes ↓

26. 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.

27. Clinical assessment • History • Examination • Investigations

28. 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

29. Red Flags • Age <15; >50 • Duration >1mnth • History of cancer • Loss of weight • Rest pain • Night pain • Fever • Morning stiffness

30. 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

31. Always examine the abdomen

33. In most cases cause of backpain not seen on back exam

34. Examination of the back • Deformity • Gibbus • Tenderness • Movement/ stiffness

35. Neurologic examination • Signs of sciatic nerve irritation -SLR -Bowstring test • Nerve root entrapment • Caudaequina

36. Straight leg raising test: 70° 50° 20°

37. Nerve fall-out: Reflexes Muscle power Sensation Sphincters

39. Investigations • ESR/CRP • FBC • xr

40. Treatment • Anaelgesics/nsaids • Bed rest , less than 3 days • Traction? • Muscle relaxants – valium • Physiotherapy • Psychologic support

41. rehabilitation