Back Pain ADAM ANDROLIA FAMILY MEDICINE BOARD CERTIFIED PRIMARY CARE SPORTS MEDICINE CAQ CONCORD ORTHOPAEDICS
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1 Back Pain ADAM ANDROLIA FAMILY MEDICINE BOARD CERTIFIED PRIMARY CARE SPORTS MEDICINE CAQ CONCORD ORTHOPAEDICS
2 My Background Family Medicine Residency Palmetto Health Richland Columbia SC Primary Care Sports Medicine Fellowship University of South Carolina Concord Orthopaedics Many Hats
3 Overview Epidemiology Definitions Red Flag Symptoms Minor Orthopaedic spinal conditions Orthopaedic Emergency (Structural Instability) Nuerological Emergency (Neurological Compromise) Axial Back Pain Radiating Low Back Pain Non orthopaedic or neuro realted back pain Chronic Low Back Pain
4 Definitions Acute Chronic
5 Epidemiology First Episode Recurrent back pain
6 Red Flag Symptoms Significant trauma related to age Major or progressive motor or sensory deficit Bowel or bladder incontinence or retention Loss of anal sphincter tone Saddle anesthesia History of cancer metastatic to bone Suspected spinal infection
7 Minor Orthopaedic Vertebral Injury Spinous process fracture Transverse fracture Pars interarticularis fractures
8 Spinous and Transverse Fracture What is it? Diagnosis Radiology Treatment
9 Orthopaedic Emergencies Compression fracture Burst fracture Fracture dislocation Seatbelt type injury
10 Compression fracture What is it? Diagnosis Radiology Treatment
11 Burst Fracture What is it? Diagnosis Radiology Treatment
12 Orthopaedic Emergency Acute Mid/Low Back Pain Fracture Dislocation Seat Belt Injuries
13 Neurological Emergency Symptoms Infection suspected Major or progressive motor or sensory deficit New-onset bowel or bladder incontinence or retention Loss of anal sphincter tone Saddle anesthesia Physical exam findings Focal neurological defect Myelopathy
14 All Other back Pain Isolated to back (axial back pain) Back pain with radiation
15 Lumbar Strain Sprain What is it? Diagnosis Radiology Treatment
16 Pars interarticularis fractures/spondylolysis What is it? Diagnosis Radiology Treatment
17 Spondylolisthesis What is it? Diagnosis Radiology Treatment
18 Spondylosis What is it? Diagnosis Radiology Treatment
19 Hurniated Nucleus Pupolsus What is it? Diagnosis Radiology Treatment
20 Disc Herniation Lumbar Spine Neurologic Examination Findings in Patients with Acute Low Back Pain Disc Herniation Motor deficit Sensory Deficit Reflex Central Paracentral Lateral L3 Hip flexion Anterior/medial thigh Patella Above L2-L3 L2-L3 L3-L4 L4 Knee ext Ant. leg/medial foot Patella Above L3-L4 L3-L4 L4-L5 L5 Dorsiflexion Lat. leg/dorsal foot Medial Above L4-L5 L4-L5 L5-S1 great toe hamstring S1 Plantar flexion Posterior leg Achilles Above L5-S1 L5-S1 None lateral foot tendon
21 Disc Hernation Cervicle Spine
22 Spinal Stenosis What is it? Diagnosis Radiology Treatment
23 Non Neuro and Orthopaedic Back Pain Connective tissue disease Inflammatory spondyloarthropathy Malignancy AAA Gastrointestinal conditions Herpes Zoster Pelvis Conditions Retroperitoneal conditions
24 Chronic Low Back Pain What is it? Epidemiology Differential Diagnosis Imaging
25 Chronic Low Back pain Medications Elephant in the room is opiod pain medication use
26 Chronic Low Back Pain Monitoring severity and symptoms of low back pain Oswestry Disability Index SF 12
27 Chronic Low Back Pain What other options besides medication for treatment?
28 Overview Red Flag Symptoms Minor Orthopaedic spinal conditions Orthopaedic Emergency (Structural Instability) Nuerological Emergency (Neurological Compromise) Axial Back Pain Radiating Low Back Pain Non orthopaedic or neuro realted back pain Chronic Low Back Pain
29 Bibliography Diagnosis and Treatment of Acute Low Back Pain BRIAN A. CASAZZA, MD, Am Fam Physician Feb 15;85(4): i The 5-Minute Sports Medicine Consult 2 nd edition Mark D. Bracker Common Questions About Chronic Low Back Pain Christopher Herdon, PharmD; Kimberly Zomberi, MD, Bruce Gardner, MD, Am Fam Physician May 15;91(10): es/rm/ png
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