Lumbar Spinal Musculature Sacroiliac Joint Quadratus Lumborum MuscleDifferential Diagnosis Mechanical Low Back or Leg Pain The Leading Cause Of Low Back Pain (97%) Types: Lumbar strain (70%) Degenerative processes of disks and facets (10%) Herniated disk (4%) Spinal stenosis (3%) Osteoporotic compression fracture (4%) Spondylolisthesis (2%) Traumatic Fracture ( Congenital Disease ( Visceral Disease (2% of All Low Back Pain) Types: Disease of pelvic organs: prostatitis, endometriosis, chronic PID Renal Disease: nephrolithiasis, pyelonephritis, perinephric abscess Aortic aneurysm GI disease: pancreatitis, cholecystitis, penetrating ulcer Nonmechanical Spinal Conditions (1% of All Low Back Pain) Types: Neoplasia: multiple myeloma, mets, lymphoma, leukemia, spinal cord tumors, retroperitoneal tumors, primary vertebral tumors (0.7%) Infection: osteomyelitis, septic diskitis, paraspinous abscess, shingles (0.01%) Inflammatory arthritis: Ankylosing spondylitis, psoriatic spondylitis, Reiter’s syndrome, IBD(0.3%) Radiculopathy: Herniated Nucleus Pulposis (HNP) L4-S1 in 95% of cases of radiculopathy L2-4 in 2-5% 75% of those with cauda equina syndrome have saddle anesthesia L5 radiculopathy: pain/dysesthesia in posterior thigh and anterolateral leg; foot drop with weakness on dorsiflexion S1 radiculopathy: pain/dysesthesia in posterior thigh and leg, posterior lateral foot; weak plantar flexion; decreased Achilles reflex Compression Fracture: Acute, severe onset of focal pain Elderly, prednisone therapy and SLE predispose Pain will resolve spontaneously in 3-6 months Inflammatory Back Disease: morning stiffness, symptoms better with activity, worse with rest, young person ( Ankylosing Spondylitis Reiter’s Syndrome Arthritis of Inflammatory Bowel Disease Psoriatic Arthritis Spinal Stenosis: better with flexion of back, bilateral neurologic deficits, wide-base gait Degenerative (seen in elderly; most common) Congenital Pseudoclaudication/Neurogenic claudication Infection Mycobacterium Tuberculosis (Pott’s Disease) Paravertebral Abscess Intervertebral discitis or osteomyelitis Herpes Zoster Pyelonephritis Endocarditis Primary cancer: Multiple myeloma Lymphoma Metastatic cancer: Pancreatic Prostate Breast Renal Cell Thyroid Lung Colon Red Flags Weight loss, fever History of cancer, exposure to TB, IV drug abuse Age > 50 Adenopathy Neurological symptoms uni/bilateral urinary retention saddle anesthesia Writhing in pain (visceral/vascular) Unrelenting pain at rest (infection/ malignancy) Physical Exam Inspection Posture shoulders and pelvis level normal lordotic/kyphotic curve present Skin abnormalities Gait Palpation Range of motion Flexion (> 60 degrees*) Schober’s test floor-to-finger measurement Extension (> 25 degrees*) Lateral Bending (> 25 degrees*) Rotation *values for which no disability would be assigned Neurologic examination Motor Sensory DTRs Pathologic reflexes Cord levels (Motor, sensation and reflexes)Radiographs Indications in acute low back pain: -Age > 50 -History of serious trauma -History of cancer -Pain at rest -Unexplained weight loss -Drug/alcohol abuse -Previous treatment with steroids -Temperature > 38° C or 100.4° F -Suspicion for inflammatory cause -Neuromotor deficit -Systemic symptomsBiomedical Treatment Acute: -Bed rest: patients functional in 6.6 days compared to 11.8 days for those kept ambulatory; more beneficial in radiculopathy 2 days of bed rest are as effective as 7 days and results in 45% less time away from work -Analgesics -Muscle relaxants: controversial -Aerobic exercise -Weight loss -Stop smoking Chronic -Back exercises -Williams/flexion exercises: better tolerated -Extension exercises: may be more efficacious -Physical Therapy -Ultrasound -Diathermy -TENS -Exercise instruction -Traction -Bracing: controversial; not clearly efficacious; may weaken back/abdominal musculature -Facet injection: probably not effective -Epidural Steroid Injection for radiculopathy controversial -66% with sx -33% with sx > 12 months show improvement -Narcotics in chronic LBP are best avoided -Antidepressants in low doses may be beneficial Surgery -USA rates > twice other developed countries -Important neurologic deficits (i.e., foot drop) best treated surgically -Long-term functional outcome unaffected if surgery delayed up to 12 weeks Indications: -Progressive or severe neurologic deficit -Persistent neuromotor deficit despite 4-6 weeks conservative therapy -Persistent radiculopathy, sensory deficit or reflex loss after 4-6 weeks conservative therapy with +SLR, consistent clinical findings and favorable psychosocial circumstances (no depression, substance abuse or somatization disorder)Biomedical Outcome Acute: Resolution of pain (without sciatica) in 6 weeks with nonspecific treatment in 75-90% 60% will have a recurrence within one year 50% with sciatica recover in 6 weeksTCM Disease Classification Yao Tong = “lumbar or low back pain” -According to TCM, the low back is the domain of the Kidneys. UAB can be observed in many neurologic conditions and myogenic failure. Cervical epidural injection is injecting the anti-inflammatory agent in the epidural space in the neck region under X-ray guided. The patient complained of loss of urinary voiding sensation and constipation. Alternate • Acyclovir 800 mg PO 5 times/day for 5–7 days • Valacyclovir 1 g PO TID for 5–7 days • If EITHER are used, varicella vaccines should not be given until at least 72 hours after the last dose of the antiviral drug. Herpes zoster tends to be milder in children than that in adults. THM 5) During chicken pox, the VZV (varicella zoster virus) passes from the skin lesions into cutaneous sensory nerve endings and ascends up to the sensory ganglia.
R02 − Ri R0 − Ri Rm = 0 and that the solution is R0 = 1 Ri + (Ri2 + 4Ri Rm levitra ditka )1/2. This dormant virus reactivates as herpes zoster in 10-30% of patients. In some cases, the pain is severe enough to make a person unable to move. Scientific counsel and review of the current pharmaceutical portfolio may uncover agents, including those in other therapeutic fields, that may benefit the management of UAB. It is affected by inflammatory, degenerative processes and trauma. The patient reported feeling fatigued, pain upon urination, and pain in the anal area during urination and bowel movements. as ‘Zostavax’.
It is more potent than the routine chicken pox vaccine. It is not available here. Multiparous women levitra ditka have slightly larger clitoral dimensions than nulliparous women with a total length on average 0.9 mm greater and a glans length 0.5 mm greater. It reduces incidence of zoster and severity of PHN if zoster occurs. THM 13) For pain DURING rash, we use analgesics eg. Some of the established causes of UAB include neurogenic, myogenic, aging, and medication side effects. The spinal nerves come out the spinal cord, pass through the epidural space and distribute to the body.
The patient was examined by a surgeon to see if there was an anal laceration. It reduces intensity and period of pain. Duration and tapering are individualized. THM 14) Since acute zoster pain can last several days and PHN is defined as pain > 4 weeks, start amitriptyline like drugs only if pain continues beyond 4 weeks. Treatment of PHN- amitriptyline-start 20mg/d and titrate to at least 75mg. Side effects of amitriptyline are sedation, constipation, mouth dryness, weight gain etc. Need to give for weeks to months.
Therefore, it is important to discern the major factor from the complex presentation of symptoms in an individual patient. Blocking these ganglions will interrupt the transmission of the sympathetic nerves, which mediate the pain sensation in some pain disorders. 2).