A Taxi driver

A Taxi driver

1. anatomy

   • Spine
     • movements
       • flexion
         • The superior vertebrae tilts and glides anteriorly
         • Limited by
       • extension
         • The superior vertebrae tilts and glides posteriorly
         • limited by
       • lateral flexion
         • the superior vertebrae tilts laterally and rotate
         • Limited by
       • rotation
     • regions
       • cervical
       • thoracic
       • lumbar
       • sacral
       • coccygeal
     • ligaments
       • anterior longitudinal lig
         • anterior aspect of vertebral bodies
       • posterior longitudinal lig
         • posterior aspect of vertebral bodies
       • ligamentum flavum
       • interspinous
         • spinous processes
       • supraspinous
       • intertransverse
         • transverse processes
     • MUSCLES
       • SUPERFICIAL LAYER
         • Trapezius
         • latissimus dorsi
       • DEEP LAYER
         • Levator scapulae
         • Rhomboids
         • ERECTOR SPINAE
         • splenius
     • intervertebral disc
       • characteristics
         • Flexibility
         • avascular
         • nutrients through diffusion
         • Shock absorber
         • Secondary cartilaginous
       • parts
         • annulus fibrosus
           • Peripheral part
         • nucleus pulposis
           • central soft part
       • Herniation
         • posterolaterally
         • steps
           • degeneration of annulus fibrosus
             • ruptures
               • nucleus pulposus herniates
   • Sciatic Nerve
     • characteristics
       • Major nerve of the lower limb
       • derived from the sacral plexus
       • Largest nerve In the body
     • Motor Distribution
       • directly innervates
         • Posterior compartment of thigh
         • Hamstring portion of the adductor magnus
     • terminal branches
       • tibial nerve
       • common fibular nerve
     • Sensory Distribution
       • does not have direct cutaneous functions

2. Common causes of back pain

   • Discogenic
     • Herniation
       • Protrusion
         • intact annulus fibrosus and ligament
       • extrusion
         • rupture through torn annulus and ligaments
       • prolapse
         • intact ligaments
       • Sequestration
         • Fragmentation of extruded segment
     • Degenerative
       • one or more disc deteriorate
         • aging
   • Abnormal alignment
     • lordosis
       • exaggerated lumbar curvature
     • scoliosis
       • lateral curvature
     • kyphosis

3. pain

   • psychological
     • effects of pain on patient
       • Activities of daily life
       • isolation
         • social support
       • cultural factors
       • losing confidence and self esteem
       • lack of sleep or oversleeping
   • Terms
     • radiated pain
       • pain travels from one part to another
         • by moving through a nerve pathway
     • referred pain
       • pain on different area than the damaged
       • somatic and visceral nerve fibers coverage on the same 2nd order neuron
       • has a clinical importance
       • examples
         • back pain
           • damaged pancreas
           • kidney stones
         • shoulder pain
           • injured spleen
           • heart attack
     • radicular pain
       • occurs when spinal nerve get compressed
         • herniation
         • diabetes
         • foraminal stenosis
         • scar tissue
   • unpleasant experience associated with tissue damage

4. Physical and clinical diagnosis

   • Diagnosis
     • physical examination
       • deformities
       • skin
         • discoloration
         • scars
       • muscle wasting
     • Imaging modalities
       • x ray
       • MRI
       • EMG
       • CT scan
   • History taking
     • symptoms and onset
     • duration and location
     • associated features
     • medical history

5. Back Surgeries

   • signs you need back surgery
     • A slipped disk
     • bone spurs
     • spinal infection
     • broken bone
   • Types of back surgery
     • Discectomy
       • surgery to remove a herniated or degenerative disc
     • Laminectomy
       • create spaces by removing lamina
     • spinal fusion surguries
       • connect vertebra
     • artificial discs

6. Treatments of lower back pain

   • anti-inflammatory drugs
   • Ice and heat
   • physical therapy
   • Electrical Stimulation
   • back surguries
   • Cortisone injections
   • Short-Term Bracing

7. VAS scale

   • use
     • used in epidemiologic and clinical research
   • interpretations
     • 0-4mm: No pain
     • 5-44mm: Mild pain
     • 45-74mm: moderate pain
     • 75-100mm: severe pain
   • No difference between horizontal and vertical VAS
   • merits and demerits
     • merits
       • < 1min
       • no training is requried
     • demerits
       • assessment is highly subjective
       • Are of less value for comparing across a group