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WhycalledherniateddiscWhyspecialfocusforlumbarIncidenceandsocialfactorMorphalogyMostcommonMostdisturbingIntroductionObjectivesIdentifytheanatomyofthelowerback
Understandthetypesoftraumathatcancauseaherniateddisc
Identifythesignsofaherniateddisc
Beabletoevaluatepatientswithpotentialherniateddiscs
AlsoabletofollowatypicaltreatmentprogramforlumbarherniateddiscsLumbarAnatomyThelumbarsectionofthespineismadeupofthelower5vertebraeCommonlyreferredtoasL1toL5L5connectstothetopofthesacrumAnatomyofLumbarVerebraThevertebralbodyisathinringofdenseboneConsistingofthebody,pediclesandliminaeVertebralforamenisawholeinvertebralbodythatspinalcordrunsthroughGellikeTissuebetweeneachvertebrafibrocartilaginouscushionsserveasthespine'sshockabsorbingsystemprotectthevertebrae,brain,andotherstructuresThediscsallowsomevertebralmotionextensionandflexion.DiscsfunctionThediscismadeupof3structurestheNucleuspulposus,gelatinouscenterAnnulusFibrosus.ItsjobistocontainthenucleusVertebralendplatesthatattachthedisctothevertebraeDiscsstructureHerniateddiskOccurwhenthereisenoughpressurefromthevertebraeaboveandbelowThiscanforcenucleuspulposusthroughaweakenedortornpartoftheannulusfibrosus.Therupturednucleuswilloftencomeincontactwithandpressonnervesnearthedisc.HerniateddisksareoneofthemostcommoncausesofbackpainMechanismofinjuryAged----------diskshaveworndownovertimeoverweight------------extrapressureontheintervertebraldisksImproperliftingform,Twistingviolently------suddenstrainthatcouldpossibleherniateadiskSymptomsLowerbackpain,sharpandshootingpaintherunsdownlowback,buttocksanddownthethighPain,weakness,numbnessortinglinginthelegs,buttocksandfeetProblemswithbowel,bladderorerectilefunction,inseverecasesHowcanwerecognizeaherniateddisk?SignsLumbarcurvatureisflattenedorevenkyphoticSidebendingtowardtheoppositesideofthepainusuallyrelievesthepainThestraightleg-raising(SLR)testwithradiatingpainbelowkneelevelseemsreasonablyassociatedtodischerniationObviouslyneurologicsignsalteredsensibility,reflexes,musclestrength,andmuscleatrophyshouldbetested.NeurologicsignsLocatednerverootandinvolvedsegmentNeurologicsignsQuads/TibialisAnteriorPatellarreflexSensoryGreattoeandmediallegL4NeurologicsignsL5StrengthofAnkleandgreattoedorsiflexionExtensorHallucisLongusSensorytodorsumoffootNeurologicsignsS1AnklereflexesandsensationofposteriorcalfandlateralfootPeroneals/GastrocAchillesreflexSensorytolateralandplantarfootDiagnosisGenerallyisbasedonthesymptomsoflowerbackpain.examineyoursensation,reflexes,gaitandstrengthX-ray--High-energyradiationisusedtotakepicturesofthespine.MagneticResonanceImaging(MRI)
--AnMRIprovidesdetailedpicturesofthespinethatareproducedwithapowerfulmagnetlinkedtoacomputer.ComputedTomography(CT)Scan--ACTscanusesathinX-raybeamthatrotatesaroundthespinearea.Acomputerprocessesdatatoconstructathree-dimensional,cross-sectionalimage.Electromyography(EMG)--Thistestmeasuresmuscleresponsetonervousstimulation.MRIMAGEDiagnosisHerniatedDisc(“slippeddisc”)TypesofherniationDegeneration:
chemicalchangesassociatedwithagingcausedehydrated,collapsedandweak,butwithoutafrankherniation.Prolapse:
thediscbulgesandmaycauseslightnarrowingofthespinalcanal,alsoknownasbulgeorprotrusion.Extrusion:
nucleuspulposusrupturesthroughtheannulusfibrosusbutremainswithinthedisc.Sequestration:
nucleuspulposussqueezedout,liesoutsidethediscandwithinthespinalcanal.L4vertebraL5vertebraL4exitsaboveherniationL5&lowerarecompressedL4/L5discherniationTypesofherniationCentralPosterlateralLateralDifferenciationCategoriesofLowBackPain(CAMPBELL’S)ExtrinsiclesionsUrogenitalsystem,gastrointestinalsystem,vascularsystem,endocrinesystem,nervoussystemnotlocalizedtothespine,extrinsicmusculoskeletalsystemInfections,tumors,metabolicdisturbances,congenitalabnormalities,associateddiseasesofagingIntrinsiclesionsSpinalmusculoskeletalsystem,localhematopoieticsystem,localneurologicsystemTrauma,tumors,infections,diseasesofaging,immunediseasesDifferentialDiagnosisofLowBackPain
Diseaseorcondition
Patientage(years)
Backstrain
20to40discherniation
30to50
Osteoarthritisorspinalstenosis
>50
Spondylolisthesis
Anyage
Ankylosingspondylitis
15to40
Infection
Anyage
Malignancy
>50
ATULT.PATEL,ABNAA.OGLE.DiagnosisandManagementofAcuteLowBackPain[J].AAFP,Vol.61/No.6(March15,2000).
DifferentialDiagnosisofLowBackPain
Diseaseorcondition
Locationofpain
Backstrain
Lowback,buttock,posteriorthigh
discherniation
Lowbacktolowerleg
Osteoarthritisorspinalstenosis
Lowbacktolowerleg;oftenbilateral
Spondylolisthesis
Back,posteriorthigh
Ankylosingspondylitis
Sacroiliacjoints,lumbarspine
Infection
Lumbarspine,sacrum
Malignancy
Affectedbone(s)
DifferentialDiagnosisofLowBackPain
Diseaseorcondition
AggravatingorrelievingfactorsBackstrain
Increasedwithactivityorbendingdischerniation
Decreasedwithstanding;increasedwithbendingorsitting
Osteoarthritisorspinalstenosis
Increasedwithwalking,especiallyupanincline;decreasedwithsittingSpondylolisthesis
IncreasedwithactivityorbendingAnkylosingspondylitis
MorningstiffnessInfection
Varies
Malignancy
Increasedwithrecumbencyorcough
ATULT.PATEL,ABNAA.OGLE.DiagnosisandManagementofAcuteLowBackPain[J].AAFP,Vol.61/No.6(March15,2000).DifferentialDiagnosisofLowBackPain
Diseaseorcondition
Signs
Backstrain
Localtenderness,limitedspinalmotiondischerniation
Positivestraightlegraisetest,weakness,asymmetricreflexesOsteoarthritisorspinalstenosis
Milddecreaseinextensionofspine;mayhaveweaknessorasymmetricreflexesSpondylolisthesis
Exaggerationofthelumbarcurve,palpable"stepoff"(defectbetweenspinousprocesses),tighthamstringsAnkylosingspondylitis
Decreasedbackmotion,tendernessoversacroiliacjointsInfection
Fever,percussivetenderness;mayhaveneurologicabnormalitiesordecreasedmotion
Malignancy
Mayhavelocalizedtenderness,neurologicsignsorfeverTreatmentConservativetreatmentoflowerdiscpainusuallyissuccessfulovertime,includes:Painmedicationorpaintherapiessuchasultrasound,massageortranscutaneouselectricalnervestimulationAnti-inflammatorymedicationsuchasaspirin,ibuprofenandacetaminophenPhysicaltherapyEducationinproperstretchingandpostureRestAlthoughperformingphysicalTherapydoesnotdirectlyhelpthedisks,itdoesstrengthenthemusclesaroundit,soastoincreasestability,whichcanhelppreventherniateddisksinthefuturePhysicalTherapyTreatmentPhysicalTherapyExercisesExercise#1whilelyingonyourbackbendyourleftkneeup.Clenchabsandbutt,keepingbackinneutralposition.Raiseyourotherlegabout12inofffloor,whilekneeisstraightHoldthepositionfor3secondsThenlowerleg,dofor10repsRepeatthesamewithyourotherlegEB-CMERehabilitationHerniateddiskscanvaryinseverityandtherehabilitationplancanvarydependingontheseverityofthesymptoms;Phase#1Rest-Lastfrom2daysupto2monthsdependingonthenatureoftheinjury,typicallytheolderthepatientthelongertherestperiod.Phase#2Aftersymptomssubsided,anywherefrom10daystoafewmonthsexercisesshouldbedonetostrengthenmusclesaroundspinalcolumntohelppreventanotherhernia.TheseexercisesmaybedonewithsomeslightlowerbackpainRehabilitationHamstringstretchLaydownfaceupwithonelegindoorwayotherlegonwallThisstretchesoutligamentsandtendonsthatconnectfromlegtolowerbackCatandCamelOnyourhandandknees,allowyourbacktosagfor5seconds,thenarchyourbackfor5secondsRepeatfor10repsRehabilitationReturntoplayPatientsthathassustainedaherniateddisktoreturntoplayhe/shemusthaveclearancefromtheirdoctorThiswillnotusuallyhappenuntilallpain,andnumbnesshasgonecompletelySurgerySurgeryisveryrarelyrequiredforherniateddisksNonoperativetreatmentisalmostalwaysdonepriortosurgeryGenerallyifsymptoms,suchaspainandnumbnessgrowworseovertimesurgeryisrequiredIfherniateddiskinterfereswithbladderandbowlmovements,surgeryisalsore
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