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BACKPAIN DR.DIJESH SHAH MERU NURSING HOME VIDYANAGAR BHAVNAGAR M-9825205215

BACKPAIN DR.DIJESH SHAH MERU NURSING HOME VIDYANAGAR BHAVNAGAR M-9825205215. Why?. Penalty of erect posture. 4/5 of adults suffer. Anatomy of Back. Vertebrae Neck– seven cervical vertebrae Chest- 12 thoracic vertebrae Abdomen- five lumber vertebrae Pelvis- sacrum Tail-coccyx

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BACKPAIN DR.DIJESH SHAH MERU NURSING HOME VIDYANAGAR BHAVNAGAR M-9825205215

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  1. BACKPAINDR.DIJESH SHAHMERU NURSING HOME VIDYANAGAR BHAVNAGARM-9825205215

  2. Why? • Penalty of erect posture

  3. 4/5 of adults suffer

  4. Anatomy of Back Vertebrae Neck– seven cervical vertebrae Chest- 12 thoracic vertebrae Abdomen- five lumber vertebrae Pelvis- sacrum Tail-coccyx Most vulnerable cervical 567 Lumber 45

  5. Bones (vertebra)-Block Ligaments –Binders Disc –Cushion Muscles –Support & movers Nerve –Conductors ( Motion & sensation)

  6. ANATOMY

  7. disc 23 spongy shock absorbers between the 24 vertebrae

  8. Structure of Inter vertebral Disc strong fibrous outer casing - called the Annulus fibrosus - and a soft, squashy, jelly-like interior called the Nucleus pulposus -

  9. Simple Backache Presents 20-55 years Pain in lumbosacral area, buttocks and thighs “mechanical” pain patient well includes muscle or ligament strain and facet joint problems

  10. SPRAINS • IMPROPER LIFTING OF HEAVY WEIGHT • HEAVY WORK • ACCUMULATION OF STRESS WITH ONE PARTICULAR EVENT UNLEASHING THE PAIN

  11. Lumbo Sacral Sprain C/F:- Muscle spasm Tenderness Painful and restricted movements

  12. Management Bed rest Analgesic Radiant heat and short wave diathermy Active spinal exercise once pain subsides

  13. WHEN TO CONTACT A DOCTOR /INVASTIGATE • CONSTANT-INTENSE PAIN PRESENT DURING LYING DOWN OR AT NIGHT • INCRESE IN PAIN WHILE COUGHING • PAIN RADIATING TO LEG. • WEAKNESS, NUMBNESS OR TINGLING IN LEGS. • BLADDER/ BOWEL INVOLVEMENT. • FOLLOWING A FALL/INJURY • FEVER/ WEIGHT LOSS • NEW PAIN AFTER AGE OF 50.(CANCER/OSTEOPOROSIS)

  14. SCREENING/DIAGNOSIS • CLINICAL EVALUATION • NEUROLOGY:MOTOR/SENSORY/REFLEX • SLR • POSTURE • MOVEMENT OF SPINE: FORWARD BENDING, EXTENSION, LATERAL ROTATION

  15. PLAIN X-RAYS • MORE IMPORTANT IS LAT. VIEW. • BREAK/ FRACTURE OF PARS INTERARTICULARIS -SPONDYLOLYSIS

  16. PLAIN X-RAYS ALIGNMENT-SPONDYLOLISTHESIS.

  17. PLAIN X-RAYS SPINAL CANAL DIAMETER-SPINAL CANAL STENOSIS.

  18. PLAIN X-RAYS • DISC SPACE NARROWING. (MISINTERPRETATION COMMON )

  19. PLAIN X-RAYS • LOSS OF LUMBER LORDOSIS (MUSCLE SPASM). • DEGENERATION OF SPINE (SPONDYLOSIS).

  20. PLAIN X-RAYS • FRACTURES.

  21. PLAIN X-RAYS • TUBERCULOSIS/ NEOPLASMS

  22. SPECIFIC CAUSES • SCIATICA: HERNIATED DISC CAUSING PRESSURE ON A NERVE

  23. Prolapsed Disc "a slipped disc" is most commonly wrongly used. 1.All discs do not and cannot slip. 2. a "slipped disc" is much less frequent

  24. C/F:- Shooting pain Pain radiating down the leg below the knee Aggravated by coughing/sneezing Usually sudden onset and often no trauma

  25. L4/5 Prolapse L5/S1 Prolapse Straight Leg Raising reduced Ankle Jerk present Weakness Big Toe Foot Dorsiflexion Sensory Loss Medial foot • Straight leg raising reduced • Ankle jerk absent • No weakness • Sensory loss Lateral foot

  26. DEGENERATION OF DISC– LOSS OF WATER CONTENT • NAROWING OF HIGHT • REDUCED SPACE BETWWEN VERTEBRAE • OSTEOPHYTE FORMATION • COMPRESSION OF NERVE ROOT- SCIATICA

  27. Osteoarthritis (lumbar spondylosis) Common cause for low backache C/F:- Backache of gradual onset with stiffness Osteophytes compression leads to acute pain with sciatica and nerve root compression Restricted movements

  28. Spondylolysis Break in the pars interarticularis in the fifth or rarely 3rd lumbar vertebra ,bridged by fibrous tissue. C/F :- Deep boring low back pain

  29. Spondylolisthesis One vertebre slips on another Alignment is lost

  30. Clinical Features Dull low backache Pain radiating to leg +/- Pain relieved by rest, aggravated by hard work. O/E:- short trunk with abnormal transverse loin creses and flat buttocks.

  31. SPINAL STENOSIS • SPACE ARROUND SPINAL CORD & NERVE ROOT NARROWS DUE TOARTHRITIS, BONE OVERGROWTH, LIGAMENTUM -FLAVUM HYPERTROPHY

  32. Lumbar Canal Stenosis narrowing of lumbar canal leading to the compression of cauda equina. C/F:- On walking pain and paraesthesia in the buttocks and one or both lower limb. Has to sit while walking. Normal on first step. If patint has pain while walking & relieved by standing – Think of vascular problem O/E:- No tenderness and muscle spasm SLR –painless. Long standing case –neurological deficit +/- Management:- laminectomy

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