BACKACHE IN ADOLESCENCE BLOCK 14

1. BACKACHE IN ADOLESCENCE BLOCK 14

2. WHAT’S SPECIAL

3. 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

4. CAUSES • Mechanical • Pathological

5. 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

6. TREATMENT

7. Clinical assessment • History • Examination • Investigations

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

9. 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

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

11. Red Flags • Any neurologic deficit -saddle numbness -urinary incontinence -urinary retention • Radicular pain • Stiff back

12. TREATMENT • Disease specific

13. Causes in adolescence • Infection - Acute discitis • - Tuberculosis • Tumours - osteoidosteoma • Trauma - spondylolysis • Scheurmann’sdiseases

14. Pathology • Clinical examination • Investigation • Treatment

29. Backache in children should always be regarded as pathological