SYMPTOMS Pain Sciatica Stiffness Deformity Numbness or paraesthesia Urinary symptoms Other.
-
Upload
lionel-lynch -
Category
Documents
-
view
255 -
download
2
Transcript of SYMPTOMS Pain Sciatica Stiffness Deformity Numbness or paraesthesia Urinary symptoms Other.
SYMPTOMS Pain Sciatica Stiffness Deformity Numbness or paraesthesia Urinary symptoms Other
Signs with the patient standingLook
› Skin› Shape and posture
Feel› Tenderness
Move› Flexion / Extension› Rotation / Lateral flexion
Signs with patient lying face downwards› Bony outlines› Tenderness› Sensations and Power› Femoral stretch test
Signs with patient lying on his back› Straight leg raising test (sciatic stretch)› Neurological examination of lower limbs› Circulation in the limbs› Rectal examination
0 Total paralysis1 Barely detectable contracture2 Not enough to act against gravity3 Strong enough to act against
gravity4 Still stronger but less than
normal5 Full power
Plain x-rays› AP and lateral views› Oblique views › PA view of S.I. Joint
Computed tomography (with mylography)
MR imaging Radioisotope scanning Discography and facet joint
arthrography
Lifetime incidence ranges from 60 -80%Most cases resolve spontaneouslyD/Dx:
› Simple back pain (non specific low back pain)
› Nerve root pain› Possible serious spinal pathology
Presentation 20 - 50 years Lumbosacral, buttocks and thigh “Mechanical” pain Patient well Specialist referral not required
Vast majority improve within 2 months Symptomatic Rx with Aspirin/NSAIDs Bed rest should be limited to 1-2 days ? Corsets, TENS, Traction Exercise - Stretching & range of motion
active
Pain that persists after 3 months < 5% of patients with L.B.P develop
Ch.L.B.P Multiple factors
› Disc, facet joints, annulus fibrosis, ligaments Psychosocial factors Surgery is rarely helpful Functional restoration programme
Uncommon in very young and the very old
Nerve root pain follows the dermatome of the involved nerve
Pain is generally worse in the leg than in the back
Exacerbation of leg pain by straining, sneezing or coughing
Localised neurological signs
Large midline disc prolapse Compresses several nerve roots Sphincter disturbance Saddle anaesthesia Prompt surgical intervention
Conservative› Bed rest for 48-72 hours› NSAIDs› Epidural steroids› 85% relief rate
Surgical treatment› 10-15% of patients ultimately require surgery› More rapid relief but the ultimate end point is
the same regardless of treatment
Commonest cause of neurologic leg pain in older patients
Symptoms Neurogenic claudication - Vascular
claudication Treatment
Presentation under age 20 or onset over 55
Thoracic pain Past hx of carcinoma, steroids Unwell, weight loss Widespread neurology Structural deformity Abnormal blood parameters
Forward slippage of one vertebral body on another
Causes› Congenital› Isthmic› Traumatic› Pathologic› Degenerative
Treatment
Forward slippage of one vertebral body on another
Deformity may occur in either coronal or sagittal plane
Scoliosis - Lateral curvature of the spine› Structural› Nonstructural
Kyphosis - Sagittal plane deformity in the thoracic or thoracolumbar spine
Idiopathic Scoliosis80% of all scoliosis
Adolescent - age 10 or overJuvenile - age 4 to 9Infantile - age 3 or under
Structural scoliosis presenting at or about the onset of puberty and before maturity80 % of cases of idiopathic scoliosisMostly (90%) in girlsPredictors of progression
very young agemarked curvatureRisser sign
Treatment Prevent a mild deformity from becoming severeCorrect an existing deformity
Nonsurgical treatmentCurves between 20-40 when spinal growth is incompleteCurves >30 (Risser 2 or less) even if no progression
Surgical treatmentCurves >40 in skeletally immatureUnbalanced curves between 20 - 40 in skeletally immatureCurves >50
Due to congenital anomalous vertebral development
HemivertebraeWedged vertebraeFused vertebraeAbsent or fused ribs
TreatmentEarly fusion in progressive curves
CausesPoliomyelitisCerebral palsySyringomyeliaFriedrich’s ataxiaMuscular dystrophies
Typical paralytic curve is long, convex towards the side with weaker muscles
TreatmentMild curves No treatmentModerate curves with spinal stability
As for idiopathic scoliosisSevere curves Fitting a suitable sitting support
Surgical stabilization of the entire spinal segment
Postural (Round back) Compensatory Structural
CausesPostural kyphosis Postradiation
kyphosisScheuermann’s disease Metabolic
disordersMyelomeningocele Skeletal dysplasiasTraumatic kyphosis Tumourous
conditionsPostsurgical Infections
Excessive thoracic kyphosis (Cobb angle >45° with wedging of 5° or more) of at least 3 adjacent apical vertebrae and vertebral end plate irregularities
Aetiology unknownIncidence 1% of general
population with slight female dominance
TreatmentOrthotic treatment
Skeletally immature - Milwaukee brace (poor compliance)
Surgical (rare)Severe deformity in skeletally matureSevere deformity and neurologic
signs