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

Causes in adolescence Infection - Acute discitis - Tuberculosis Tumours - osteoid osteoma Trauma - spondylolysis Scheurmann’s diseases

Pathology Clinical examination Investigation Treatment

Backache in children should always be regarded as pathological