BACK PAIN - Bradford VTS
BACK PAIN ON 2 SIDES OF A4
[pic]
Epidemiology:
|[p|150 000 000 working days per year lost in UK |
|ic| |
|] | |
|[p|4-fold increase in 20 years but no change in the incidence of back pain |
|ic| |
|] | |
|[p|costs UK £6 billion per year |
|ic| |
|] | |
|[p|peak incidence 45-60 years |
|ic| |
|] | |
|[p|manual workers, smokers, social class 4 and 5 most affected |
|ic| |
|] | |
|[p|obesity and tallness associated, posture is not |
|ic| |
|] | |
Aetiology:
Mechanical strains predominate. Need to exclude spinal stenosis, neoplasms, metabolic bone disease, disc problems. Principal risk factor is previous history of back pain.
Simple Back Ache:
|[p|onset age 20-55 |
|ic| |
|] | |
|[p|lumbo-sacral pain, not spreading beyond thigh |
|ic| |
|] | |
|[p|mechanical in nature |
|ic| |
|] | |
|[p|patient well |
|ic| |
|] | |
|[p|90% recover within first 6 weeks |
|ic| |
|] | |
Nerve Root Pain:
|[p|unilateral leg pain worse than back pain |
|ic| |
|] | |
|[p|pain to foot or toes |
|ic| |
|] | |
|[p|numbness and paraesthesia in same distribution |
|ic| |
|] | |
|[p|signs of nerve irritation, reduced straight leg raising |
|ic| |
|] | |
|[p|motor, sensory or reflex change limited to one nerve root |
|ic| |
|] | |
|[p|50% recover in 6 weeks |
|ic| |
|] | |
Emergency Referral:
|[p|difficulty with micturition |
|ic| |
|] | |
|[p|loss of sphincter tone or faecal incontinence |
|ic| |
|] | |
|[p|saddle anaesthesia about anus, perineum, genitalia |
|ic| |
|] | |
|[p|widespread (more than 1 nerve root) pr progressive motor weakness in legs or disturbed gait |
|ic| |
|] | |
Prognosis:
Most off for a few days, 90% are back in work in 6 weeks. Of those still off after 1 year, only 25% will return to employment. Of those still off at 2 years, only 10% will ever return to employment.
Danger Signs:
|[p|age 55 |
|ic| |
|] | |
|[p|violent trauma |
|ic| |
|] | |
|[p|constant, progressive, non-mechanical pain |
|ic| |
|] | |
|[p|thoracic pain |
|ic| |
|] | |
|[p|past history of malignancy |
|ic| |
|] | |
|[p|use of systemic steroids |
|ic| |
|] | |
|[p|misuse of drugs or HIV infection |
|ic| |
|] | |
|[p|systemically unwell |
|ic| |
|] | |
|[p|weight loss |
|ic| |
|] | |
|[p|persisting severe restriction of lumbar flexion |
|ic| |
|] | |
|[p|widespread neurological signs |
|ic| |
|] | |
|[p|structural deformity |
|ic| |
|] | |
Tutorial prepared by Dr P Harrop, Riversdale Surgery, Bridgend 20 March 2002
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- chronic back pain diagnosis
- new lower back pain procedures
- lower back pain surgery
- chronic back pain and disability
- chronic back pain disability
- latest back pain procedures
- injections for back pain procedure
- back pain with movement only
- epidural for back pain procedure
- back pain and autoimmune disorders
- back pain and nerve damage
- pinched nerve back pain relief