Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Felix Jaimin
Penolong Pegawai Perubatan U29
      Jabatan Kecemasan
   Hospital Queen Elizabeth
Location of kidneys drawn on back
 Non-specific musculoskeletal pain:
 the most common cause of back pain.
 Patients present with lumbar area pain that d...
 Radicular Symptoms:
 Often referred to as quot;sciatica,quot; this is a pain syndrome
  caused by irritation of one of ...
 Spinal Stenosis:
 Pain starts in the low back and radiates down the buttocks
  bilaterally, continuing along the backs ...
 Mixed symptoms:
 In some patients, more then one process may co-exist,
 causing elements of more then one symptom
 synd...
 Look and examine the patient condition.
 Walking, on wheel chair or on stretcher?
 Categorize the patient to red zone ...
 From patient or relatives and/or friends about history of
  allergies, alcohol, drugs abuse, medical history and current...
4) Trauma, particularly if of substantial force.

5) Osteoporosis, which increases risk of
    compression fracture (verte...
6) Pain referred to the back from other areas of the
   body (e.g. intra-abdominal or retroperitoneal
   processes). Could...
 Fracture?
 Prolapse of vertebra disc?
 Osteoporosis?
 Spondylitis?
 Osteomyelitis
 UTI?
 Renal Calculi?
Red Zone                 Yellow Zone                  Green Zone

• Trauma cases/spinal #   • trauma cases               •...
15 – 30 yrs : prolapse disc, trauma, fractures, ankylosing
              spondylitis, pregnancy.
30 – 50 yrs : degenerativ...
 MRI
 X-Ray
 CT-scan
 FBC
 BUSE
 UFEME
 Non-operative
 Operative
      - foramenotomy, bone grafting or laminectomy.
 Usually no cause is found, so treat empi...
Palpate the spine. Processes that inflame the bone (e.g. compression fracture,
osteomyelitis, metastatic disease) will gen...
Location of kidneys drawn on back. In the setting of kidney
infection (pyelonephritis), percussion over this area will cau...
Backache
Backache
Backache
Upcoming SlideShare
Loading in …5
×

Backache

1,303 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Backache

  1. 1. Felix Jaimin Penolong Pegawai Perubatan U29 Jabatan Kecemasan Hospital Queen Elizabeth
  2. 2. Location of kidneys drawn on back
  3. 3.  Non-specific musculoskeletal pain:  the most common cause of back pain.  Patients present with lumbar area pain that does not radiate, is worse with activity, and improves with rest.  There may or may not be a clear history of over use or increased activity.  The pain is presumably caused by irritation of the paraspinal muscles, ligaments or vertebral body articulations.  However, a precise etiology is difficulty to identify.
  4. 4.  Radicular Symptoms:  Often referred to as quot;sciatica,quot; this is a pain syndrome caused by irritation of one of the nerve roots as it exits the spinal column.  The root can become inflamed as a result of a compromised neuroforamina (e.g. bony osteophyte that limits size of the opening) or a herniated disc (the fibrosis tears, allowing the propulsus to squeeze out and push on the adjacent root).  Sometimes, it's not precisely clear what has lead to the irritation.  patient's report a burning/electric shock type pain that starts in the low back, traveling down the buttocks and along the back of the leg, radiating below the knee. The most commonly affected nerve roots are L5 and S1.
  5. 5.  Spinal Stenosis:  Pain starts in the low back and radiates down the buttocks bilaterally, continuing along the backs of both legs.  Symptoms are usually worse with walking and improve when the patient bends forward.  This is caused by spinal stenosis, a narrowing of the central canal that holds the spinal cord. The limited amount of space puts pressure on the nerve roots when the patient walks, causing the symptoms (referred to as neurogenic claudication).  Pain in calfs/lower legs due to arterial insufficiency, pain resolves very quickly when person stops walking and assumes upright position. Also, peripheral pulses should be normal.
  6. 6.  Mixed symptoms:  In some patients, more then one process may co-exist, causing elements of more then one symptom syndrome to co-exist.
  7. 7.  Look and examine the patient condition.  Walking, on wheel chair or on stretcher?  Categorize the patient to red zone (critical), yellow zone (semi-critical) or green zone (non-critical) based on the patient condition.
  8. 8.  From patient or relatives and/or friends about history of allergies, alcohol, drugs abuse, medical history and current medication.  The key points in the Hx include: 1) Pain that doesn't get better when lying down/resting. 2) Pain associated by systemic symptoms of inflammation (e.g. fever, chills), in particular in those at risk for systemic infection that could seed the spinal area (e.g. IV drug users, patients with bacteremia). 3) Known history of cancer, in particular malignancies that metastasize to bone (e.g. prostate, breast, lung).
  9. 9. 4) Trauma, particularly if of substantial force. 5) Osteoporosis, which increases risk of compression fracture (vertebrae collapsing under the weight they must bear). More common as people age, women > men. 5) Anything suggesting neurological compromise. In particular, weakness in legs suggesting motor dysfunction. Also, bowel or bladder incontinence, implying diffuse sacral root dysfunction. Note: it can sometimes be difficult to distinguish true weakness from motor limitation caused by pain.
  10. 10. 6) Pain referred to the back from other areas of the body (e.g. intra-abdominal or retroperitoneal processes). Could include: Pyelonephritis, leaking/rupturing abdominal aortic aneurysm, posterior duodenal ulcer, pancreatitis, etc.
  11. 11.  Fracture?  Prolapse of vertebra disc?  Osteoporosis?  Spondylitis?  Osteomyelitis  UTI?  Renal Calculi?
  12. 12. Red Zone Yellow Zone Green Zone • Trauma cases/spinal # • trauma cases • non trauma cases. • GCS 13 and below • GCS 14/15 • pt condition stable • Pt on stretcher. • pt on stretcher or wheel • able to walk or on wheel chair. chair
  13. 13. 15 – 30 yrs : prolapse disc, trauma, fractures, ankylosing spondylitis, pregnancy. 30 – 50 yrs : degenerative spinal disease, prolapse disc, malignancy (lung, breast, prostate, thyroid, kidney) >50 yrs : degenerative osteoporosis, paget’s, malignancy, myeloma, lumbar canal/lateral recess spinal stenosis.
  14. 14.  MRI  X-Ray  CT-scan  FBC  BUSE  UFEME
  15. 15.  Non-operative  Operative - foramenotomy, bone grafting or laminectomy.  Usually no cause is found, so treat empirically; arrange physiotherapy or manual theraphy.  Giving analgesic and carrying on with life is better than bed rest or physiotherapy
  16. 16. Palpate the spine. Processes that inflame the bone (e.g. compression fracture, osteomyelitis, metastatic disease) will generate pain when the affected vertebrae is palpated or percussed.
  17. 17. Location of kidneys drawn on back. In the setting of kidney infection (pyelonephritis), percussion over this area will cause pain.

×