AN ULTIMATE VISION OF LOW BACK ACHE
Back pain is a common clinical problem. It may be brought about by pathological processes affecting
1. Nerve endings in capsules of apophyseal joints, spinal ligaments, vertebral periostreum, and attached fasciae and lindoms, duramatter and epidural adipose tissue, walls of arlorioles supplying vertebral cancellous bone and walls of epidural and prevertebral veins.
2. Afferent fibres in torsal nerve roots and their branches.
3. Spasm of Paravertebral muscles.
4. Pain receptor systems in visceral tissues segmentally innervated from dorsal spinal nerve roots
Causes are numerous and are listed below. It has to be admitted that in many cases the cause is not found, but it is important to consider the possibility it back pain in a particular-------- is due to some serious Underlying disease such as and this is the purpose of the following classification.
1. Normality. Non - disease
2. Phychogenic
3. Non- infective, traumatic, degenerative and mechanical disorders.
Bad postcere and strain
Injuries Disc lesrons
Fatigue Osteo arthritis spondylolis this is-
Obesity Sacroiliac Strain-
Pregnancy
4. Generalized disease of born and metabolic disorders:
Osteoporosis
Osteo malacia
Hyper parathyroidism
Pagets disease
Acromegaly
Renal Osteodystrophy
Gaucher’s disease
Flurosis
Hypophosphataemic Spondylopathy
Idiopathic bypoparathyroidism
Back pain may also be normal for after unaccustomed gardening by an atrophic disc- bound tycoon. It is also a common symptom of psychological disturbance and may start or become a source of a complaint as a result of some social domestic (or) Matrimonial trouble.
When backpain is normal (or) psychogenic, not the result of disease, it is particularly - important to make the correct diagnosis since an inappropriate diagnosis of disease (Such as ‘ arthritis of the spine’ often diagnosed on the basis of degenerative changes on x-ray which are common before and universal after the age of 55) may it self be disabling apart from normality, psychological disorders and situational states most cases of back ache are due to traumatic, degenerative and mechanical conditions, in which it is often impossible to make an exact diagnosis.
1. Did your pain begin a fall, a twisting injury or when you lifted an object?
2. Do you have numbness or pain extending down your leg?
3. Do you have a sudden loss of bladder or bowel control, or weakness of a leg? (You may have a slipped disk, or HERNIATED DISK).
4. Does the pain stay in your lower back and become worse with twisting or bending? (your pain may be from MUSCLE SPAM, a PULLED MUSCLE or a COMPRISSED NERVE).
5. Did you have sudden and serve pain with minimal motion fall and are you over age 60, or do you have arthritis or some changes in your spine? (You may have a COLLAPSED VERTEBRA or a crushed spine. Though it’s extremely painful, it’s usually not dangerous).
6. Do you have pain that comes and goes in your lower that may have started in your teen years and was possibly aggravated by an injury? (Spondylolisthesis or Spondylosis).
7. Do you have a fever? (Your symptoms may be from a kidney infection, Pyelonephritis. Kidney stones may start a kidney infection or may cause pain, blood and painful urination without a fever).
8. Do you have blood in your urine and one-sided back pain along with burning during urination? (You may have a viral illness such as the FLU).
9. Do you have a blistering rash and burning pain on your back and chest? (Your pain may be from a viral infection called Shingles).
10. Do you have stiffness in the morning or are joints also stiff, sore, swollenor red? (Ankylosing Spondylitis is a from of arthritis that affects the lower back. Other forms of arthritis can also cause back pain).
11. Are you pregnant? (Pregnancy causes stretching of the ligaments around the uterus and pressure on the lower back).
12. Is the pain centered in the lower spine and do you have pain radiating down your leg to your knee or ankle? (You may have ruptured or Herniated disk).
C SPINAL CANAL STENOSIS
The term canal stenosis covers any type of narrowing of the lumbosacral or cervical canal, nerve tunnels or intervertebral foramina.
(1) Do you have the following causes?
a. Prolapse of the intervertebral disc.
b. Hypertrophic changes within the narrow spinal canal
c. Angulation of vertebrae due to loss disc height
THE PELVIC GIRDLE
The brim, formed by the promontory of the sacrum, the iliopectineal line (on each side), and the crest of the pubic bones. The outlet is bounded by the coccyx and the ischial tuberosities.
The Joints of the Pelvis. The sacro-iliac joint is an articulation between the articular surfaces of the ilium (which are called auricular because of their similarity in shape to the auricle of the ear), and the sides of the sacrum. Only slight movement is possible at this joint as very strong ligaments unite the articulating surface, limiting movement in all directions.
The symphysis pubis is a cartilaginous joint between the pubic bones, which are separated by a pad of cartilage.
Clinical Notes
The curves of the vertebral column. The skeleton at the end of the book (side view) shows the bony framework in good postural standing position and the vertebral column, the antero- posterior curves well balanced. And exaggeration of the back ward thoracic convexity results in round back or kyphosis. This round back is a cause of poor thoracic expansion, often associated with disease of the chest, such as bronchitis. The head is poking forward and the chest flat. In exaggeration of the forward tumbar convexity, hollow back or lordosis, the pelvis is tilted forwards, the abdominal muscles relaxed, and strain is thrown on the ligaments at the frond of the hip joined . In both kyphosis and lordosis flat foot may result .
The intervertebral discs shown in Fig. may be effected by accident or age. Each fibro- cartilage or disc has a jelly- like center or mucleus contained in a fibrous capsule. Prolapse of this mucleus through the capsule- prolapsed intervertebral disc- may cause pressure on adjacent nerve roots leading to pain and sometimes loss of power in the area of distribution of the nerve or nerves affected. A prolapsed lumbar disc is common cause of sciatica. Disc shrinkage with degenerative changes occur in ageing.
The spine may be fractured either by direct violence as in a severe crushing accident or indirectly as when a weight falls on head and shoulders and the spine, unable to adapt to the weight, snaps. The commonest accident result in a fracture dislocation and in this the spinal code may be badly injured between the displaced vertebrae.
The symptoms are those described in transection of the spinal cord .
The pelvis also may be fractured and, if in two places, over- riding of the fragments may result in injury to some of the pelvic organs. It may be contracted in the case of a small woman, thus narrowing the inlet; in the rachitic flat pelvis, rarely seen in this country, the inlet is considerably decreased in diameter, making the childbirth difficult or impossible.
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