Case presentation Backache Backache Dr F Pato MBCHB (Stell)
Dec 14, 2015
Case presentation
BackacheBackache
Dr F PatoMBCHB (Stell)
Presenting history
• 44yr male
• Sudden onset backache while driving
• Non-radiating
• Unable to move as a result thereof.
• No neurological symptoms.
• First episode of such complaint.
• No other complaints
Previous history
• PMH: DM for 1yr,
• PSH: Nil
• Meds: Daonil
• Allergies: Nil
• Social: Smoking- alcohol-
Clerical work
Sedentary lifestyle,
Examination
• GCS 15/15
• Height 1.68m
• Weight 79kg
• BMI 27.9
• Vitals within normal limits
• CARDIOVASCULAR– Pulses regular and equal
– Cap refil <3s
– No abnormalities noted
– S1 S2
RESP
•No signs of distress
•Equal chest expansion
•Resonat percussion
•Air entry good bilaterally
ABDOMEN•Central obesity
•Bowel sounds present
•Soft and non-tender
•No organomegaly palpable
• Patient moving• N0 deformities/ scars• Tender over lower back
NEURO• Power 5/5• Tone normal• Reflexes intact• Sensation intact (3/3)
Examination cont.
Assessment:– ?mechanical backache
– ?muscle spasm
– ?slipped vertebral disc
– ?fracture
Managemnet
• X-ray
• Analgesia
• Bed rest
• Orthopaedics consult
• CT scan not working• MRI not available
Loss of function, income, disability
Discussion: Backache
• +/- 80%
• Self limiting
• Disabling disease
• 75% spontaneous recovery 2-3/52
• 5% ends up with surgery
• Classified according to age group
Children
• Red flag
• trauma
• infectious conditions: discites vertebral osteomyelitis.neoplastic condition
Teenagers
• Postural
• Deformities
• Trauma
• Infections
Young adults• 20-40yrs
• Occupation
• Disc lesions
• Ankylosing spondylitis
• Trauma
• Infective conditions
• Spondylolysis
• Spondylolisythesis
Older adults
•Degenerative conditionsScoliosis L4/L5Spondylolisthesis 5F’s
• Spinal stenosis• Malignancy• Weight• Osteoporosis• Vascular
Other conditions
• Urogenital
• Gastrointestinal
• Gynaecological
Approach to backache
• Good clinical history• Careful examination• Well planned special examinations• Management
Good clinical history
•Onset
•Duration
•Aggravating and alleviating factors
•Distribution
•Grading
Thorough examination•Look•Feel•Move: flexion, extension, lateral flexion, rotation, muscle power•Full neurological examination: •Motor•sensory (3-point scale) distribution •Reflexes
• Well planned special examinations
• Xrays
• MRI
• Myelography
• Radio isotopes
• Serology
• Management
• Conservative vs surgery
• Conservative
• Physiotherapy
• Kinetic handling, mobilization, muscle balancing, symptomatic treatment
• Medication
• Work placement
–Surgery
–Failure of conservative management
–Unstable fractures
–Pathological fractures
–Disc herniation and root compression
–Complications
bibliograpy
• Concise system of orthopaedics and fractures 2nd edition, A G Apley. L Solomon
• Current surgical diagnosis and treatment 11th edition, L W Way. GM Doherty
• Lecture notes, Prof JGVlok, Stellenbosch university,2005
• Vlok JG, backache: a great medical problem, SA Orthopaedic Journal,Aug,2006,18-24