Instance of Back Agony.

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Category: Animals / Pets
bowing over at work and had seen a mellow back torment, which advanced ... Shivering in upper appendages, noted to have decreased reflexes. Instance of Back Pain ...
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Instance of Back Pain 53 year old, right gave woman, hotelier 3 day history of serious lower back agony and shortcoming in her legs twisting around at work and had seen a mellow back torment, which advanced Night and rest torment, leg radiation, more regrettable with development. Not able to walk

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Case of Back Pain Sep 05Haematologists shoulder agonies, lymphadenopathy and rash, weariness, 7 kg weight reduction in 6 months l-hub < 1cm ALP 210 Rheum referral Subsequently conceded Ex In agony confined spine ? leg shortcoming and changed sensation feet

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Case of Back Pain ALP 320, ALT 89 CRP 96 XR typical MRI spine ordinary Symptoms advanced Tingling in upper appendages, noted to have lessened reflexes

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Case of Back Pain CSF protein 2.55 g ?Guillan-Barre Transferred to neurology IV Ig, Rehab, FVC, vitals checking Campylobacter IgG and IgA 160 EBV +ve

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GB disorder Post-infective intense incendiary demyelinating polyneuropathy 1-3 weeks post viral Distal deadness and shortcoming – develops over days to weeks rising Back and leg agony can be a component 20% serious with autonomic and respiratory inconveniences Weakness, areflexia, tactile misfortune

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GB disorder Rare – visual and ataxia – Miller-Fisher disorder NCS: moderating of conduction or piece CSF: 1-3g/l IV Ig, steady, ventilation, plasmapharesis, recovery

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BACK PAIN Jaya Ravindran Rheumatologist

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Causes Simple mechanical eg ligamentous strain Degenerative sickness with/without neural, line or channel bargain Metabolic – osteoporosis, Pagets Inflammatory – Ankylosing spondylitis Infective – bacterial and TB Neoplastic Others, (trauma,congenital) Visceral

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Red banners Age <20 or >50 with back torment for the 1 st time Thoracic torment >50 yrs Pain taking after a fierce harm/injury Unremitting, dynamic torment

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Red banners Past or ebb and flow history of tumor On Steroids or immunosuppressants Drug abuser or +ve HIV Systemic manifestations - fever, appetitie and weight reduction, discomfort

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Red banners Bilateral leg radiation, tangible/engine/sphincter side effects Pain overwhelmingly around evening time

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Inflammatory banners Morning solidness and torment >30 mins - 1 hr Better with action Peripheral joint association Anterior uveitis Psoriasis Inflammatory gut illness Recent GI or GU disease Family history

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Myotomes C5 Deltoid, (biceps jerk) C6 Wrist extensors, (biceps, brachioradialis jerk) C7 Wrist flexors, finger extensors, (triceps jerk) C8 Finger flexor, thumb extensors (triceps jerk) T1 finger abductors

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Myotomes L2 Hip flexion L3 Knee expansion (knee jerk) L4 Knee augmentation, lower leg dorsiflexion (knee jerk) L5 toe dorsiflexion S1 foot plantar flexion, eversion

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Examination LOOK – deformation, muscle squandering, kyphosis, scoliosis LOOK – ordinary cervical lordosis, thoracic kyphosis, lumbar lordosis FEEL – spinal procedures and sacroiliac joints

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Examination MOVE – Lumbar flexion Schober\'s test – marks at "dimples of Venus" and 10 cm above. Measure at maximal flexion – typically 5 cm MOVE – Lumbar parallel flexion MOVE – Cervical flexion/augmentation, sidelong pivot and flexion, thoracic revolution

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Examination Sciatic stretch (patient prostrate) - Straight leg raise and dorsiflexion of foot - torment in calf and back thigh between 30-70 o – low lumbar (L5/S1) sore or sciatic disturbance Femoral stretch (patient inclined) – knee is flexed and after that hip developed – torment in foremost thigh – high lumbar (L2-L4) sore

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Imaging XR – tumor, break, contamination, irritation Bone sweep – expanded turnover eg contamination, metastatic illness, cracks, Pagets MRI – delicate tissue, plates, aspect joint, nerve roots, rope, aggravation

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Degenerative ailment and sciatica Very regular Facet joint OA, circle ailment, osteophyte Mechanical back agony Sciatica – most resolve NB relentless, neurology, reciprocal, warnings Analgesia, PT, torment facilities

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Degenerative malady and sciatica

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Malignancy Unremittting, dynamic and night torment Systemic symtoms Past hx Ca Breast, bronchus, thyroid, kidney, prostate and myeloma/plasmacytoma Osteolytic (prostate osteoblastic) XR can be ordinary in early stages – further imaging if suspicion high Predilection for vertebral body and pedicles

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Infection discitis, osteomyelitis, and epidural ulcer. hematogenously spread frequently Staphylococcus aureus. Gram-negative poles in postoperative or immunocompromised patients typical skin greenery is less normally segregated in postoperative patients. Postoperative patients create side effects 2 to 4 weeks after surgery after an underlying change in agony.

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Infection Pseudomonas living beings in intravenous medication clients. Mycobacterium tuberculosis in creating countries and outsider populace. Contagious diseases are uncommon. Stand out third have fever and 3% to 15% present with neurologic deficiency. Contaminations normally include the intervertebral plate and vertebral body endplate

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Infection Radiographic changes at 2 to 4 weeks bone sweep can be certain as right on time as 2 days 75% particular. X-ray appearance is diminished T1-and expanded T2-weighted sign in the contaminated plate. Upgrade after gadolinium

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Infection Conservative treatment of anti-infection agents, unbending propping to anticipate distortion and control torment Surgery : neurologic shortfall, nearness of boil, broad bone misfortune with kyphosis and precariousness, disappointment of blood work and biopsy to segregate any creature, extraction of a sinus tract, or no reaction to traditionalist treatment.

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T scores

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Low bone thickness

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Osteoporosis - dangers History of low injury # - colles, NOF, vertebral, sacral or pelvic inadequacy Steroids Maternal history of NOF # Gonadal hormone lack Ca insufficiency Prolonged stability Low BMI Alcohol and smoking

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Causes of low bone thickness

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Vertebral cracks

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Osteoporosis Bisphosphonates SERMs Strontium Teriparatide Calcitonin Lifestyle components Ca and Vit D

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7-dehydrocholesterol daylight cholecalciferol (diet) liver 25-hydroxycholecalciferol kidney 1  - hydroxylase 1,25-dihydroxycholecalciferol (- ) expanded GI Ca2+ ingestion  Ca2+ Bone resorption Thyroid (- ) Parathyroid Gland PTH  Renal Ca2+ (- ) Calcitonin reabsorption

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Spinal stenosis Canal or foraminal narrowing with conceivable consequent neural pressure Cause Ligamanetum flavum hypertrophy , aspect joint hypertrophy, vertebral body osteophytes, herniated circle Rare: Pagets, AS, acromegaly

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Spinal stenosis Symptoms Age - >50 Dull throbbing agony in the lower back and legs Exertional leg torment/shortcoming/deadness Symptoms calmed inclining forward, sitting or lying Examination May be typical Normal sensation and force Reflexes ordinary or marginally decreased Normal foot beats

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Spinal stenosis

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Spinal stenosis Conservative – analgesics, NSAIDs, PT, epidural Surgery – laminectomy (+arthrodesis)

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Cauda Equina Syndrome Back torment, lower appendage shortcoming, saddle anesthesia, sphincter unsettling influence, feebleness Causes – generally plate, once in a while tumor, ulcer, progressed AS Diminished sensation L4 to S2 (sacral deadness), shortcoming lower leg and plantar dorsiflexion, misfortune lower leg jerks, urinary maintenance, misfortune butt-centric tone Urgent MRI and surgical decompression

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Cauda Equina Syndrome

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Pagets Pain, disfigurement Skull, long bone, vertebra, pelvis, close hip Neurologic bargain Planned surgery ?ALP 2X ULN Rare: high yield disappointment

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AS NSAIDs Sulphasalazine – fringe joints PT Anti-TNF

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