Adult Back Pain / Sciatica

Extrinsic lesions

 

Urogenital system - tumour / stones

 

Gastrointestinal system

 

Vascular system - AAA

 

Intrinsic lesions

 

Trauma

- fracture, HNP, facet dislocation

 

Infection

- vertebral osteomyelitis, TB

 

Tumour

- benign / OO / OB / ABC / Giant cell

- primary malignant / Ewing's / OS / Lymphoma

- secondary malignant / metastasis / MM

 

Inflammatory

- RA

- seronegative

 

Metabolic

- gout / CPPD / onchronosis

 

Endocrine

- PTH

 

Neuromuscular

- spinal dysraphism

 

Degenerative

 

Dysplasia

- Achondroplasia, dysraphism

 

Congenital

- Scheurmann's

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Waddell's Signs

 

3 or more to be significant

 

DR TOS

 

1 Distraction

- FLIP SLR (Sign 1)

 

2 Regional

- Non-anatomically numb or weak

- Esp Cogwheel Give Way

 

3 Tenderness

- Superficial "Pinch Test" (Sign 2)

- Non-anatomic

 

4 Over-Reaction

      Collapse

      Verbalisation

      Sweating

 

5 Simulation

- Axial loading by head compress

            (Sign 3)

- Passive Pelvic rotation (Sign 4)

      2° Thoracic rotation

 

Successful Discectomy

 

6/6 Nachemson

 

1.  Leg pain > back pain

2.  Neurological symptoms dermatomal

3.  Neurological signs dermatomal

4.  Signs of nerve tension

5.  Correlation with imaging

6.  > 6 weeks