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The Worn-Out Back: Aging and Arthritis

The Worn-Out Back: Aging and Arthritis. Carol Sue Carlson, MD April 3 rd , 2012. The Worn Out Back: Aging and Arthritis. Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation.

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The Worn-Out Back: Aging and Arthritis

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  1. The Worn-Out Back: Aging and Arthritis Carol Sue Carlson, MD April 3rd , 2012

  2. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  3. “The Worn-Out Back” - Definition • “Axial Pain” • Complaints of Back Pain > Leg Pain • “Degenerative Joint Disease” • “Facet Syndrome”

  4. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  5. Lumbar Spine Overview

  6. Lumbar Spine Overview

  7. Lumbar Spine Basic Functional Unit • 2 Consecutive Vertebrae • Intervertebral Disc • Facet Joints • Combined Changes  • Arthritis • Stenosis

  8. Lumbar Spine Potential Pain Sources

  9. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  10. Diagnosis – History • Where Does it Hurt? • Usually BACK PAIN > LegPain • Type of Back Pain • Dull, Aching Pain • Mechanism of Injury • Acute Onset? • Trauma, Lifting Injury, Fall • Gradual Onset? • Arthritis, Stenosis • Exacerbating/Alleviating Factors • Sitting, Standing, Bending, Twisting, Walking

  11. Diagnosis – Physical Examination • Gait • Forward Flexed • Cane/Walker • Range of Motion of Lumbar Spine • Limitations of Motion • Direction of Pain Exacerbation

  12. Diagnosis – Physical Examination • Strength & Sensation • Neurologic Exam Reflexes

  13. Diagnosis – X-Rays Normal Abnormal

  14. Diagnosis – MRI

  15. Diagnosis – CT Scan

  16. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  17. Associated Diagnoses – Foraminal Stenosis

  18. Associated Diagnoses – Central Stenosis

  19. Associated Diagnoses – Spondylolisthesis

  20. Associated Diagnoses – Cyst  Sciatica

  21. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  22. Facet Pain – Imposters • Sacroiliac Joint Pain • Trochanteric Bursitis • Discogenic Pain • Compression Fractures • Referred Pain • Ligaments • Muscles

  23. Imposters –Sacroiliac Joint

  24. Imposters – Trochanteric Bursitis

  25. Imposters – Discogenic Pain

  26. Imposters – Compression Fractures

  27. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  28. Facet Pain – Treatment • Activity Modification • Decrease Sitting, Bending, Twisting, Lifting • Avoid Bed Rest (<2-3 Days) • Low-Intensity Aerobic Exercise • Bicycling, Swimming, Walking

  29. Facet Pain – Medications Tylenol Anti-Inflammatories Muscle Relaxants Topicals

  30. Facet Pain – Physical Therapy • Core Strengthening** • Flexion/Extension Biased Exercises • Stretching • Range of Motion • Traction • Heat/Ice • Massage • TENS Unit

  31. Facet Pain – Treatment Acupuncture Chiropractic Bracing Injections Surgery

  32. The Worn Out Back: Aging and Arthritis Definition Lumbar Spine Overview Diagnosis Associated Diagnoses Imposters Treatment Medial Branch Blocks and Radiofrequency Ablation

  33. Facet Pain – Medial Branch Blocks • Anatomy • Innervation • Each Joint Has 2 Nerves • 1 From Above • 1 From Below • Ex: L5-S1 Facet Joint • L4 Nerve Superiorly • L5 Nerve Inferiorly

  34. Facet Pain – Medial Branch Blocks • Diagnostic Injection: • Selectively Block a Facet Joint • Identify Patients Appropriate for Radiofrequency Ablation • Injected Medications: • Long-Acting Steroid • Local Anesthetic • Performed under X-Ray to Ensure that the Medication is Placed in the Proper Location Sedation is Offered to Relax You For the Procedure

  35. Facet Pain – Medial Branch Blocks

  36. Facet Pain – Medial Branch Blocks

  37. Facet Pain – Medial Branch Blocks

  38. Facet Pain – Radiofrequency Ablation • After Positive Response to MBB (>50% Relief) • Usually Not Permanent • 1-2 Years of Relief • Needle is Placed • Nerve is Tested to Ensure Proper Placement • Nerve is Anesthetized • Needle Tip is Heated 90 sec • Nerve is Severed

  39. Facet Pain – Radiofrequency Ablation

  40. Thank You! Carol Sue Carlson, MD Chippewa Valley Orthopedics and Sports Medicine

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