TAXI DRIVER

Mr.singh is 43 years old taxi driver, his job support his wife and his 3 kids
2. he use to be veterinarian in india but since he came to uae he has worked a taxi dirver
  1. he has a history of 10 years of nagging pain in his lower back pain. it first began when he was treating various animals.
    1. the pain was aggravated by long period of sitting and heavy lifting
      1. one night as he was lifting suitcase he felt pain shooting down his right leg
        he took tablet of Voltaren but the pain increased after 24 hours as it radiated to is right foot and become more severe. sitting in taxi aggravated his pain.
        he could feel his pain in lower back, buttock, back of thigh, outer side of leg and little toe, and sole of foot (all at right side)
        pain level measured on a visual analogue scale and it was 70mm (7cm).
        he found that standing and walking relieved the pain while sitting made it worse.
        he felt numbness in his little toe with tingling sensation (sensory neuron)
        he started limbing (claudication) his posture was abnormal with forward and lateral tilt (SCOLIOSIS) to right side
        there was hardness of lower back muscles with spasms of erector spinae msucle. movement os spine in flexion, extension and lateral flexion was generally painful.
        THE GP told Mr.Singh has sciatica many conditions could be the cause of this compression
        he started with physiotherapy. five days later there was improvement
        Nonsurgical Treatment for Sciatica
        Heat/ice
        For acute sciatic pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn.
        Pain medications
        Over-the-counter or prescription medications are often effective in reducing or relieving sciatica pain. Nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), or oral steroids can reduce the inflammation that is usually part of the cause of pain. Muscle relaxants or narcotic medications may also be prescribed for the short term (a few days and up to 2 weeks) to alleviate pain.
        Epidural steroid injections
        If the pain is severe, an epidural steroid injection can reduce inflammation. Unlike oral medications, an injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain.
        Alternative Sciatica Treatment
        Chiropractic/manual manipulation
        Acupuncture
        Massage therapy
        What it is sciatica ??
        The term sciatica describes the symptoms of leg pain—and possibly tingling, numbness, or weakness—that originate in the lower back and travel through the buttock and down the large sciatic nerve in the back of each leg.
        Sciatic Nerve
        Largest Nerve in the body
        Originates from the lumbosacral nerves L4 , L5 , S1 , S2 , S3
        Has two major branches : -Tibular nerve -common fibular branch
        there is 2 types of pain
        reffered pain
        pain felt in a part of the body other than its actual source.
        radicular pain
        pain the move along the course of nerve
        Abnormal Curvatures
        causes of lordosis
        osteoporosis, obesity, discitis, spondylolisthesis
        causes of kyphosis
        abnormal vertebrae development, poor posture or slouching, arthritis, spinda bifida, spine infections or tumors.
        pain at right leg and there is right scoliosis???
        right sciatic nerve will be effected which will effect right muscle supply, so the muscles at left will work more and become more dominant and causing contraction to left side so spine will tilt to right side
        History taking
        Visual Analogue Pain VAS
        Measures intensity of pain 0 to 4 mm 0 to 0.4 cm >no pain---- 5 to 44 mm/ 0.5 to 4.4 cm>mild pain ----45 to 74 mm/ 4.5 to 7.4 cm> moderate pain---- 75 to 100 mm/ 7.5 to 10 cm >severe pain
        after history taking
        look (inspection)
        Posture / deformity ( straight / scoliosis / ankylosing spondylitis : joint Posture / deformity
        Skin (scar/abnormal hair/pigmentation)
        Muscle wasting
        after look
        palpation
        Body attitude Antalgic gait (severe LBP)
        Soft tissues
        swelling and muscle spasm.
        after palpate
        move
        Extension , flexion of the spine Motor , sensory & reflex
        then finally we do special test
        Straight leg raising test
    2. causes of lower back pain
      1. lets mention most common causes of lower back pain and relate it with out case
        Back Muscle Strain
        Severe or aching pain in the lower back that starts after activity, sudden movement, or lifting a heavy object.
        symptoms
        Difficulty moving that can be severe enough to prevent walking or standing ----sudden localized pain that does not radiate ----Pain that tends to be achy and dull---- Muscle spasms, which can be severe ----Local soreness upon touch
        we will eliminate it because it causes its local pain and does not radiate
        Degenerative Disc Disease
        symptoms
        Low-level of constant lower back pain punctuated by episodes of severe pain/muscle spasms lasting a few days to a few months ----Chronic pain that can range from nagging to severe ----Back pain worsened by sitting Walking, even running, may feel better than sitting/standing ----Changing positions frequently relieves pain
        it could be the reason. also it could be osteroarthritis, because it happesn at age 45 and beyond which is close to his age and happens due to overuse of joints since he was veterinarian
        Isthmic Spondylolisthesis
        Symptoms
        Deep ache in the lower back that worsens when standing or walking
        we eliminate it because the pain is worsened when he walk or stand, while in our case the pain was better in these conditions
        Lumbar Herniated Disc
        symptoms
        Pain typically is ongoing ----Pain may be worse in the leg and foot than in the lower back---- Typically felt on one side the buttock or leg only---- Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking---- More severe (burning, tingling) vs. dull, aching pain---- May be accompanied by weakness, numbness or difficulty moving the leg or foot
        we cant eliminate it because it could be the cause

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TAXI DRIVER

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	Created by lolita klol about 7 years ago