Mapa mental

Backpain

Fatma Shwaylia Inglés

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Backpain

Anatomy of the back
- spinal column
  - consists from 33 vertebrae divided to different regions
    - Cervical region
    - Thoracic region
    - Lumbar region
    - Sacral region
    - coccyx
  - Abnormal curvatures
    - Lordosis
      - the spine of a person with lordosis curves significantly inward at the lower back
        osteoporosis, obesity, discitis, spondylolisthesis
    - kyphosis
      - characterized by an abnormally rounded upper back (more than 50 degrees of curvature).
        abnormal vertebrae development, poor posture or slouching, arthritis, spinda bifida, spine infections or tumors
    - scoliosis
      - A person with scoliosis has a sideways curve to their spine. The curve is often S-shaped or C-shaped.
        tends to run in families
  - Joints
    - The Intervertebral Discs
      - between the bodies of the vertebrae
    - Zygapophyseal Joints (facet joints)
      - synovial joints between the inferior articular process of superior vertebrae and the superior articular process of inferior vertebrae.
    - Atlanto Occipital Joint
      - articulations are between C1 (atlas) & the occipital condyles (skull).
        Nodding
    - Atlanto Axial joints
      - Two lateral joints - One medial (Pivot) joint
        saying no
  - Ligaments
    - Anterior longitudinal ligament
      - strong, broad fibrous band that covers and connects the anterior aspects of the bodies of the vertebrae and intervertebral discs.
    - Posterior Longitudinal ligament
      - narrower, weaker band than the anterior longitudinal ligament. It runs along the posterior aspect of the vertebral bodies, within the vertebral canal.
    - Ligamentum Flavum
      - laminae of adjacent vertebral arches are joined by broad, elastic bands
    - Supraspinous and Interspinous ligaments
      - join adjacent spinous processes.
    - Intertransverse ligaments
      - Connecting adjacent transverse processes.
  - Spinal Cord Functions
    - Reflexes.
      - It serves as the reflex center for all spinal reflexes for involuntary responses to stimuli
    - Conduction
      - provides tracts to conduct impulses up (afferent) and down (efferent) the cord
  - Internal structure
    - Grey matter (H-shaped)
      - Consists of 2 equal halves connected together by the Grey Commissure, which is traversed by the Central Canal.
        consists mainly of nerve cells (bodies).
    - White matter
      - - It consists of Ascending & Descending Tracts
        myelinated nerve fibers grouped together; every tract has the same cells of origin, termination& carrying out the same function
  - Disk problems
- Muscles
  - Superficial
    - Help to move the arm
      - Levator Scapulae
      - Trapezius
      - Rhomboids
        Rhomboideus Minor
        Rhomboideus Major
      - Latissmus Dorsi
  - Intermediate
    - Respiratory muscles (insert to ribs)
      - Serratus Posterior Superior and Inferior
  - Deep
    - Move trunk and back
      - Transverso-Spinalis
        Origin: transverse processes
        Insert: spines of vertebrae above.
      - SPLENIUS
        SPLENIUS CAPITIS AND SPLENIUS CERVICIS-
        Origin: Vertebrae (Spines of lower cervical, T1-T4).
        Insertion: Splenius Capitis- Skull (occipital, temporal bones) Splenius Cervicis- vertebrae (transverse processes C2, C3)
        Action: Extend neck and head; rotate in unilateral action.
    - Erector Spinae
      - SPINALIS - most medial
      - LONGISSIMUS - intermediate
      - ILIOCOSTALIS - lateral
- Sciatic Nerve
  - Largest Nerve in the body
  - Also known as the ischiadic Nerve
  - Originates from the lumbosacral nerves L4 , L5 , S1 , S2 , S3
  - Two major branches
    - Tibular nerve
    - common fibular branch
  - innervates the skin on the posterior aspect of the thigh and gluteal regions, as well as the entire lower leg (except for its medial aspect).
  - pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg
    - Sciatica
    - Treatment
      - Chiropractic/manual manipulation
        high-velocity, short lever arm thrust that is applied to abnormal vertebra with the goal of improving functionality, reducing nerve irritability and restoring range of motion in the back.
      - Acupuncture
        Alteration in the secretion of neurotransmitters and neurohormones.
        Stimulation of electromagnetic points on the body
        Release of opioid peptides
      - Cognitive behavior therapy
        taking control and changing self-defeating behaviors can be helpful in managing sciatica pain, particularly in the short term.
      - Massage therapy
        improves blood circulation
        relaxes muscles for an improved range of motion.
        leads to increased endorphin levels.
      - Spinal mobilizations
        passive movement applied to a spinal region or segment so as gently to increase the passive range of motion of that segment/region
      - Ultrasound
        uses vibration to deliver heat and energy to parts of the lower backbones.
      - Exercises
        Core muscle strength. Hamstring stretching. Aerobic exercises
      - Sciatica surgery
        for severe continuous pain+limitations in daily life
        Microdiscectomy
        lumbar disc herniation
        Lumbar Laminectomy
        lumbar spinal stenosis
Pain of the lower back
- Causes
  - Mechanical
  - Degenerative
    - lower back strain
      - muscle strain
        over-stretched or torn muscle
        damage to the muscle fibers
        Pain that also moves around
      - lumbar sprain
        when ligaments are stretched too far or torn.
        Symptoms
        Difficulty moving
        achy and dull pain
        muscle spasms
        Local soreness upon touch
      - Lifting a heavy object, twisting, or a sudden movement
    - within the disc space itself
      - a lumbar disc herniation
        when a nerve root in the lower spine is compressed, causing pain and numbness to travel along the large sciatic nerve that serves the buttocks, legs and feet.
        Symptoms
        Pain typically is ongoing
        worse in the leg and foot
        felt on one side
        worse after long periods of standing still or sitting
        More severe (burning, tingling
        accompanied by weakness, numbness or difficulty
      - lumbar degenerative disc disease.
        Symptoms
        Low-level of constant lower back pain
        Chronic pain that can range from nagging to severe
        worsened by sitting
        Walking, even running, may feel better than sitting/standing
        slight instability in the lower back, bringing about pain, muscle spasms, and sometimes sciatica.
        When the lumbar discs between the vertebrae begin to break down
      - Isthmic Spondylolisthesis
        when a vertebra in the low back slips forward on the disc space below it.
        Symptoms
        radiates into the buttocks and back of the thighs (sciatica)
        worsens when bending backward
        feels better with sitting
        leg numbness or tingling
        Tight hamstrings
  - Inflammation
  - Referred Pain
  - Neoplastic
    - Tumors
  - Metabolic
  - Psychosomatic
  - depresstion
- Psychological aspect of pain
  - Stress/anxiety
  - Depression
  - Anger/irritability/frustration
  - Sleep disturbances
  - Interference with daily activities
  - Substance abuse and addiction
  - Stress on the family/conflict
History Taking
- Greeting the patient, insure privacy
- Duration &Location
  - 10 years localized nagging pain
  - Lower Back
- Progression
  - Persistent
- Radiation
  - to the back of the right leg and foot
- Quantity
  - Very severe
    - visual Analogue Pain
      - Measures intensity of pain
- Aggravating factors
  - Prolonged sitting, heavy lifting "suitcases
- Alleviating factors
  - Lying down on firm surface and standing
- Associated symptom
  - Leg pain
- Quality
  - Nagging pain , burning or tingling and numbness
- History of medication
  - voltaren
Physical Examination
- Look
  - Posture / deformity
    - straight / scoliosis / ankylosing spondylitis : joint Posture / deformity
  - Skin
    - scar/abnormal hair/pigmentation
  - Swelling
    - cold abscess / hump / neurofibroma
  - muscle wasting
- Feel
  - Body attitude
    - Antalgic gait (severe LBP)
  - Soft tissues
  - Swelling
  - Muscle spasm
- Move
  - Extension , flexion of the spine
  - Motor , sensory & reflex
  - Special test: Straight leg raising test