Page 2 Basic knowledge of back Injury and Illness, Symptoms, Treatment and Prevention

Basic knowledge of back 

Injury and Illness, Symptoms, Treatment and Prevention

We will go over:

1) Different types of back injury,

2) Signs and symptoms of back injury

3) Treatment of Back injury

4) Back injury Prevention

Types of back injury:

Soft tissue:

strains (overuse), sprains (injury to a joint or ligament), ruptures (a tear), inflammation (tendinitis, bursitis, myositis, neuritis)

Structural:

fracture, dislocation of joint /articulation,  arthritis, disease,   

Functional: (caused from soft tissue or structural injury)

Instability, weakness, paraesthesia (loss of sensation), hyper or hypo-mobility (to much or to little range of motion (ROM))  

Common injuries and illnesses of the back:

Dislocations, Arthritis: Osteoporosis, Rheumatoid Arthritis,Tendinitis, Sprains, Strains, Bulging or Herniated Disc,Nerve Impingement,

Degenerative Disc Disease (DDD), Degenerative Joint Disease (DJD), Scoliosis, Compression Fracture, Spinal Stenosis, Pelvic Disorders,
Uncommon injuries and illnesses of the back:
Spinal Cord Injury, Meningitis, Metastatic Vertebral Tumors, Paget's Disease of bone, Thoracic Outlet Syndrome, Thoracic Outlet Syndrome, Herpes Zoster, and spondyloarthropathies (ankylosing spondylitis most often, but also enteropathic arthritis, psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthropathy).

Sign And Symptoms:
Acute or chronic musculoskeletal pain with or without radiculopathy (radiating pain)
Muscle spasm
 

Physical Evaluations:

Physical examination: Temperature and general appearance are noted. When possible, patients should be unobtrusively observed as they move into the examination room, undress, and climb onto the table. If symptoms are exacerbated by psychologic issues, true functional level can be assessed more accurately when patients are not aware they are being evaluated.

The examination focuses on the spine and the neurologic examination. If no mechanical spinal source of pain is obvious, patients are checked for sources of referred pain.

In the spinal examination, the back and neck are inspected for any visible deformity, area of erythema, or vesicular rash. The spine and paravertebral muscles are palpated for tenderness and muscle spasm. Gross range of motion is tested.

In the neurologic examination, strength and deep tendon reflexes are tested. In patients with neurologic symptoms, sensation and sacral nerve function (eg, rectal tone, anal wink reflex, bulbocavernosus reflex) are tested. These tests are among the most reliable physical tests for confirming normal spinal cord function. Corticospinal tract dysfunction is indicated by the extensor plantar response and Hoffman's sign. To test for Hoffman's sign, clinicians tap the nail or flick the volar surface of the 3rd finger; if the distal phalanx of the thumb flexes, the test is positive, usually indicating corticospinal tract dysfunction caused by stenosis of the cervical cord. Sensory findings are subjective and may be unreliable.

The straight leg raise test helps confirm sciatica. The patient is supine with both knees extended and the ankles dorsiflexed. The clinician raises the affected leg, keeping the knee extended. If sciatica is present, 10 to 60° of elevation typically causes symptoms. For the crossed straight leg raise test, the unaffected leg is raised; the test is positive if sciatica occurs in the affected leg. A positive straight leg test is sensitive but not specific for herniated disk; the crossed straight leg raise test is less sensitive but 90% specific. The seated straight leg raise test is done while patients are seated with the hip joint flexed at 90°; the lower leg is slowly raised until the knee is fully extended. If sciatica is present, the pain occurs as the leg is extended.

In the general examination, the lungs are auscultated. The abdomen is checked for tenderness, masses, and, particularly in patients > 55, a pulsatile mass (which suggests abdominal aortic aneurysm). With a fist, clinicians percuss the costovertebral angle for tenderness, suggesting pyelonephritis.

Rectal examination, including stool testing for occult blood and, in men, prostate examination, is done. In women with symptoms suggesting a pelvic disorder or with unexplained fever, pelvic examination is done.

Lower-extremity pulses are checked.

Treatment:

Acute musculoskeletal pain (with or without radiculopathy) is treated with 

Analgesics 

Heat and cold

Early mobilization followed by stabilization exercises

Acetaminophen or NSAIDs are the initial choice of analgesics, but opioids may be necessary for severe pain. Adequate analgesia is important immediately after acute injury to help limit the cycle of pain and spasm.

Acute muscle spasms may also be relieved by cold or heat. Cold is usually preferred to heat during the first 2 days after an injury. Ice and cold packs should not be applied directly to the skin. They should be enclosed (eg, in plastic) and placed over a towel or cloth. The ice is removed after 20 min, then later reapplied for 20 min over a period of 1 to 1½ h. This process can be repeated several times during the first 24 h. Heat, using a heating pad, can be applied for the same periods of time. Because the skin on the back may be insensitive to heat, heating pads must be used cautiously to prevent burns. Patients are advised not to use a heating pad at bedtime to avoid prolonged exposure due to falling asleep with the pad still on their back. Diathermy may help reduce muscle spasm and pain after the acute stage.

Oral muscle relaxants Flexeril, Robaxin, Skelaxin
Benefits of these drugs should be weighed against their CNS and other adverse effects, particularly in elderly patients, who may have more severe adverse effects. 

Although a brief initial period (eg, 1 to 2 days) of decreased activity is sometimes needed for comfort, prolonged bed rest, spinal traction, and corsets are not beneficial. Patients with severe torticollis may benefit from a cervical collar and contour pillow until pain is relieved and they can participate in a stabilization program. Spinal manipulation may help relieve pain caused by muscle spasm or an acute neck or back injury; however, some forms of manipulation may have risks for patients with disk disorders or osteoporosis.

When acute pain decreases enough that motion is possible, a lumbar stabilization program is begun. This program includes exercises that strengthen abdominal and low back muscles plus instruction in work posture; the aim is to strengthen the supporting structures of the back and reduce the likelihood of the condition becoming chronic or recurrent.

Clinicians should reassure patients with acute nonspecific musculoskeletal back pain that the prognosis is good and that activity and exercise are safe even when they cause some discomfort. Clinicians should be thorough, kind, firm, and nonjudgmental. If depression or secondary gain persists for several months, psychologic evaluation should be considered.