外伤科主治医师要领.pptxVIP

Low back pain and radiculopathyImaging studies and further testing not helpful the first 4 weeks Relief of discomfort with meds and spinal manipulationBed rest beyond 4 days may be more harmful 89-90% low back pain improve within 1 month 第二页，共二十八页。 80% sciatica eventually recover1% have nerve-root symptoms1-3% have lumber disc herniation85% no specific diagnosis made第三页，共二十八页。 definitions/classificationsRadiculopathy : dysfunction of nerve root ( pain, sensory disturbances, weakness) Mechanical low back pain : strain of paraspinal muscles, ligament, irritation of facet joints第四页，共二十八页。 Initial assessment of patientHistory : age, weight loss, cancer or infection, used of drug, during of S/S, trauma, cauda equina syndrome, work statusPE : fever, vertebral tenderness, limited range of spinal cord Dorsiflexation of ankle and big toe – L5, 4 Achilles reflex – S1 Light touch SLR text第五页，共二十八页。 Further evaluation of patients EMG : neuropathy, myopathy, myelopathy, unreliable 3-4 weeksSEPs (somatosensory evoked potential): spinal stenosis, or spinal myelopathyNCVs (nerve conduction velocity): entrapment neuropathies that mimic radiculopathy第六页，共二十八页。 LS X-ray recommendation age 70yrs, or 20 yrssystemically ill patientstemp. 38°CHistory of maligancyRecent infectionCauda equina syndrome Heavy alcohol or drug abusersDM第七页，共二十八页。 Immunosupressed patients (steroid)Recent traumaRecent urinary tract or spinal surgeryUnrelenting pain at restPersistent pain more than 4 weeksUnexplained weight loss第八页，共二十八页。 TreatmentConservative treatment : 1.activity modification:Bed rest : no more than 4 daysActivity modification : heavy lifting, total body vibration, asymmetric postures, sustained for long periodsExercise : walking, bicycling, or swimming第九页，共二十八页。 2.analgesics : Panadol and NSAIDs Opioids3.muscle relaxants : no effect4.education: condition will subside5.spinal manipulation therapy: acute low back pain without radiculopathy in 1st month, not used in severe or pr