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 2.Movements of back greatly limited 3.Local tenderness 4.Local muscle spasm

15. Disc degeneration Chronic low backache

17. Myelomatosis

19. METASTASES

21. Facet Syndrome

25. Spinal Stenosis: 1.Claudication pain 2.Slight forward bending and rest improves symptoms 3.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 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 Cauda equina

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

37. Nerve fall-out: 1.Reflexes 2.Muscle power 3.Sensation 4.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