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Bone 5
- 1. BONE 5 Low Back Pain Feature Very common (5th common cause of GP visit) 2nd most common in adult Causes 90% are 'mechanical' cause If mechanical - resolve after 6 weeks Non mecha is uncommon but don't miss them Mechanical injury to disk, ligament injury to muscle, bone Non mecha. spondyloarthropathy osteporosis cancer (2nd mets) infection Red Flags Major trauma Fever, wt loss or systemic symptoms Intractable pain Neurologic symptoms (esp. if bilateral) Morning pain & stiffness Hx of cancer Red Flags: Surgical Cauda equina syndrome Abdo. aortic aneurysm (AAA) Significant neuro deficit Red Flags: Spinal malignancy Pain worse at night Local tenderness Wt loss ESR elevation Worrying Conditions Herniated disk Spinal stenosis Cauda equina syndrome Inflam. spondyloarthropathy Spinal infection Cancer Low Back Pain 2 Dx Exam posture range of motion straight leg raising test neuro deficit test Imag. only do if persistent pain disk herniation, bulging Mgmt Watchful waiting - 2 or 3 days or LESS Pain relieve paracetamol NSAID codeine Exercise - good for prevention Disk herniation Spontaneuos recovery - in 6 weeks Effect - leg pain & tingling Dx - need imaging if neuro deficit Tx - pain relief Dx of Inflam. back pain Hx insidious, > 3 months age < 40 yo morning stiffness > 1 hr NSAID improve symptom Exam limited axial motion Syst. signs pink eye psoriasis urethritis perip. joint inflam. Schober's test BONE 5.mmap - 06/01/2010 - Mindjet