Taxi driver

Taxi driver

1. anatomy of the spine

   • joints
     • intervertebral disc, zygapophyseal joint, atlanto-occipital joint, atlanto-axial joint, lumbosacral joint, sacrococcygeal joint
   • ligaments
   • bones
   • movements
     • flexion
       • extension
         • lateral flexion
           • rotation
   • muscles
   • veins passing through

2. sciatica

   • caused by impingement on nerve root
     • by degeneration of annulus fibrosis and nucleu pulposis
   • start with
     • HX.
       • age, job
         • daily act
           • place, time
             • symptoms
               • blader incon
       • VAS
         • visual analogue scale test that is used to scale the pain of a patient and is usually done by patient. it is usually scaled from 0-100 mm
     • natural HX
       • improves with time, average 2 weeks
         • 1 pain
           • slow improv
   • management
     • alternative
       • massage
         • yoga
           • chairopractor
             • acupuncture
     • active/ rest
       • NSAIDS
         • physiotherapy
     • placebo effect
       • unexplained improvements that depends on: belief of patient, situation, pat-doc relationship
     • second line
       • traction steroid
       • surgery
         • sciatic nerve decompression
           • discectomy
             • laminectomy, laminotomy
       • absolute: increase neurological deficit, blader icon
         • relative: failing treatment, disabling pain
   • physical examination

3. investigation of back pain

   • history
     • onset of pain
       • location of pain
         • medical history
           • types and severity of pain
             • aggravating and releiving factors
   • radiographic evaluation
     • bone scintigraphy
     • ct scan
     • MRI scan
   • physical examination
     • overreaction
     • tenderness
     • pain stimulating test
     • nonorganic regional disturbances
     • look, feel, move
     • special tests
       • straight leg raising
       • the upper and lower neurovascular test
       • schobers test
       • abdominal exam
   • labratory tests

4. 5 dimensions of adherence

5. lower limb dermatomes

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