1 / 19

Back Pain in General Practice

Back Pain in General Practice. Dr Chris Monella GPSI. Back pain. Common 50-80% Diagnosis 15% Benefit claims >10% Risk factors. Lumber vertebrae. disc. History. Age, occupation,lifestyle Site/spread/segmental Onset Symptoms Red flag, yellow flags PMH, medications,etc. Diagnosis.

jayme
Download Presentation

Back Pain in General Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Back Pain in General Practice Dr Chris Monella GPSI

  2. Back pain • Common 50-80% • Diagnosis 15% • Benefit claims >10% • Risk factors

  3. Lumber vertebrae

  4. disc

  5. History • Age, occupation,lifestyle • Site/spread/segmental • Onset • Symptoms • Red flag, yellow flags • PMH, medications,etc

  6. Diagnosis • Capsular pattern eg degenerative OA • Non-capsular pattern eg PID • Mechanical back pain • PID • Spinal stenosis • Sacro-iliac joint pain

  7. Lumber spine examination • Observation-f,p,g • Look-ic,psis,asis,leg length,spine curvature,lordosis • Lumber active ext,lat flex,flex ?capsular • Tip-toe:Gastrocnemius root: s1,2 • Hip-passive flex, med rot, lat rot • SIJ-shear tests, faber

  8. Lumber spine examination 2 • SLR- dural sign :l4,5,s1,2 • Resisted hip flex: l1,2,3 • Resisted dorsiflexion(TA): l4,5 • Resisted ext big toe (EHL) :l5,s1 • Resisted eversion (PB/L): l5,s1,2

  9. Lumber spine examination 3 • Skin sensation • Big toe: l4 • Toes 1,2,3: l5 • Toes 4,5 : s1

  10. Lumber spine examination 4 • Reflexes • Knee :l2,3,4 • Ankle:s1,2 • Babinski

  11. Lumber spine examination 5 • Femoral stretch test:l2,3,4 • Resisted knee ext(Quads) :l2,3,4 • Resisted knee flexion(Ham):l5,s1,2 • Gluts (bulk): l5,s1,2

  12. Lumber spine examination 6 • Palpation • ?manipulation- • History recheck, noncapsular pattern,normal plantar,normal reflexes • Observe, treat or refer?

  13. Treatment • Mobilization (grade A) in acute back pain eg. Modified Pretzel technique • Acupuncture • Reassurance, ice • analgesia,NSAIDs,Amitrip., gabapentin, etc • Ix, PCT back pain clinic,Back surgeon

  14. Jarvik et al . JAMA 2004 • RCT-380 • X-ray 167 • MRI 170 • 3,6,12/12 fu • Increased reassurance, surgery/cost of care • Overall disability,pain, general health -same

  15. Gilbert et al. Health Tech assess 2004 • 782 patients, 14 hospitals • 393 early imaging • 389 delayed • 8 & 12/12 better outcome • 0.07 QALY for £61 over 24 months

  16. NICE Feb 2008

  17. oral NSAIDs including COX-2 inhibitors opioids capsaicin intra-articular corticosteroid injections paracetamol topical NSAIDs supports and braces education, advice, information access strengthening exercise aerobic fitness training weight loss if overweight/obese local heat and cold shock-absorbing shoes or insoles assistive devices TENS manual therapy (manipulation and stretching) joint arthroplasty Treatment options

  18. Summary • History,examination findings & treatments • Mechanical back pain/PID • Systemic back pain • Spinal stenosis • Sacroilitis(in ankylosing spondylitis)

More Related