外伤科主治医师要领.pptVIP

Spinal and spinal cord 外傷科主治醫師 Hsinglin Low back pain and radiculopathy Imaging studies and further testing not helpful the first 4 weeks Relief of discomfort with meds and spinal manipulation Bed rest beyond 4 days may be more harmful 89-90% low back pain improve within 1 month 80% sciatica eventually recover 1% have nerve-root symptoms 1-3% have lumber disc herniation 85% no specific diagnosis made definitions/classifications Radiculopathy : dysfunction of nerve root ( pain, sensory disturbances, weakness) Mechanical low back pain : strain of paraspinal muscles, ligament, irritation of facet joints Initial assessment of patient History : age, weight loss, cancer or infection, used of drug, during of S/S, trauma, cauda equina syndrome, work status PE : fever, vertebral tenderness, limited range of spinal cord Dorsiflexation of ankle and big toe – L5, 4 Achilles reflex – S1 Light touch SLR text Further evaluation of patients EMG : neuropathy, myopathy, myelopathy, unreliable 3-4 weeks SEPs (somatosensory evoked potential): spinal stenosis, or spinal myelopathy NCVs (nerve conduction velocity): entrapment neuropathies that mimic radiculopathy LS X-ray recommendation age 70yrs, or 20 yrs systemically ill patients temp. 38°C History of maligancy Recent infection Cauda equina syndrome Heavy alcohol or drug abusers DM Immunosupressed patients (steroid) Recent trauma Recent urinary tract or spinal surgery Unrelenting pain at rest Persistent pain more than 4 weeks Unexplained weight loss Treatment Conservative treatment : 1.activity modification: Bed rest : no more than 4 days Activity modification : heavy lifting, total body vibration, asymmetric postures, sustained for long periods Exercise : walking, bicycling, or swimming 2.analgesics : Panadol and NSAIDs Opioids 3.muscle relaxants : no effect 4.education: condition will subside 5.spinal manipulation therapy: acute low back pain without radiculopathy in 1st month, not used in