Upload
-
View
215
Download
0
Embed Size (px)
Citation preview
7/24/2019 Lowbackpain Thai
1/36
September 17 ,2007September 17 ,2007 11
LOW BACK PAINLOW BACK PAIN
( LBP )( LBP )
7/24/2019 Lowbackpain Thai
2/36
September 17 ,200 2
60-8060-80
! ! "#!$%"#!$%
7/24/2019 Lowbackpain Thai
3/36
7/24/2019 Lowbackpain Thai
4/36
September 17 ,200 4
22
2.2. !)+,'!)+,' systemicsystemic +,*%-+,*%-
(1)(1) !. . $+,$$!. . $+,$$ osteomyelitisosteomyelitis+,+,%!&$%!&$ epid!ra abscess epid!ra abscess(2)(2) % . % . "!ltiple myeloma "!ltiple myeloma %% %%)%%)(3)(3) #nflammatory disease#nflammatory disease .. $nkylosing spondylitis$nkylosing spondylitis($S)($S)+,"%!&$$$($%&,"$+,"%!&$$$($%&,"$(4)(4)+,$%*",(+,$%*",( %dissecting aortic ane!rism%dissecting aortic ane!rism+,+, %$%$ +,+,d!oden!md!oden!m!lcer!lcer(&)(&) "etabolic bone disease"etabolic bone disease .. 'steoporosis 'steoporosis 'steomalacia ('steomalacia (+,%!&+,%!&))()() - . ')%' +,$- . ')%' +,$
7/24/2019 Lowbackpain Thai
5/36
September 17 ,200 5
!$'(!$'(
1.1. "!,!"!,! back m!scleback m!sclestrainstrainsprainsprain '(! %*$' /0!'(! %*$' /0!
)*."1'(1&(%#!)*."1'(1&(%#!%!&$$%!&$$ (( !)!)f!nctional * str!ct!ral )f!nctional * str!ct!ral )
2.2. %!&%!& ( Herniated +isc)( Herniated +isc) '*"!!'*"!!$2($$!" !2($$2($$!" !2($$!*$'+!(%$$'($!*$'+!(%$$'()%(!$ *#"&&!))%(!$ *#"&&!)
an!l!s fibross!san!l!s fibross!s '*"'*"n!cle!s p!lpos!sn!cle!s p!lpos!s+ + -'!"$%!-'!"$%! posterior longit!nalposterior longit!nalligamentligament '*"!!$'(('*"!!$'((
7/24/2019 Lowbackpain Thai
6/36
September 17 ,200 6
!$'(!$'(
33&!#$!&&!#$!& ((Pr!m"r#Pr!m"r#$e%e&er"t!'e t*e +p!&e )$e%e&er"t!'e t*e +p!&e )!'&& !'&&
#$% (#)!#$#(!$#$% (#)!#$#(!$!! #$#!$$!!!* (#!! #$#!$$!!!* (#
+!!( (+!!( ( O+tep*#teO+tep*#te $$ +pr+pr!&!!&! !&t +p".e!&t +p".e ".et !&t".et !&t", #$", #$ "&/+ !br++"&/+ !br++
7/24/2019 Lowbackpain Thai
7/36
September 17 ,200 7
!$'(!$'(
44 Sp!&"/ +te&+!+Sp!&"/ +te&+!+ !#(#)!,$!*!#(#)!,$!*+p!&"/ ."&"/+p!&"/ ."&"/ (",(#(",(#O+tep*#teO+tep*#te $$+pr+pr(-!&%! (!(-!&%! (! /!%"me&t/!%"me&t "(#$!&!"(#$!&! $#(#()$' $#(#()$'&! #$#) !&! #$#)!* #$"!( "(.%!#$* #$"!( "(.%!#$
!!! "#!#'!!! "#!#'(( ./"$!."t!& )./"$!."t!& )
7/24/2019 Lowbackpain Thai
8/36
September 17 ,200 8
!$'(!$'(
&.&. +,%!&+,%!& (( 'steoporosis )'steoporosis ) *#"&&+!*#"&&+!2%#"&3$$!%)! *'(2%#"&3$$!%)! *'(,4+,!4 !$$,4+,!4 !$$
")10 !$ %$")10 !$ %$1"!2($! *"$)%(1"!2($! *"$)%(compression fract!recompression fract!re %!&$$ 1"(%!&%!&$$ 1"(%!&
$$$%(!'$%')%'*"$$$%(!'$%')%'*"" $%!&),," $%!&),,."- $"$' '*"(%$,."- $"$' '*"(%$,
7/24/2019 Lowbackpain Thai
9/36
September 17 ,200
// L b". p"!&L b". p"!&
1.1. /$%$%) )2$/$%$%) )2$%+,%+,1.11.1 /$$5%!/$$5%!
%%%%!$!$ %% $$ "--"-- " -" -!$(!(!$(!( ( ,ack pain )( ,ack pain )!$"!$" (( leg pain )leg pain )
.!".!"((-!mbness )-!mbness )!.0 1"!!.0 1"! !!(0 1"!"$!!(0 1"!"$ $$$$,!,! is!al /ain Scaleis!al /ain Scale
7/24/2019 Lowbackpain Thai
10/36
September 17 ,200 10
1.21.2 /$%$/$%$$5%'('$5%'(' %% $+6%$+6% *."*."(.!.)!(.!.)!705705&(&( !"!"
%$!)*!(%$!)*!(%$!$*,,$%$!$*,,$%$$5%$$5 0,/0,/+!'42%'+!'42%'%$+,$%$+,$ %% ,!$+&,!$+& +,+,
$*)$*) %% +,%!&+,%!&""'(%)'(%)"" $!$! ((
7/24/2019 Lowbackpain Thai
11/36
September 17 ,200 11
1.31.3 ))1.3.11.3.1 gaitgait
'!'!%%
#!#!1.3.21.3.2 post!re post!re $($( ((listing)listing) $,$, (( kyphosis)kyphosis) $$ ( lordosis )( lordosis ) $,!$,! ( scoliosis )( scoliosis )
1.3.31.3.3 l!mbofemoral rhythml!mbofemoral rhythm #!#!1.3.41.3.4 Straight leg raising test (S0)%Straight leg raising test (S0)%
t .t .,, 0t .0t .
5ross leg raising test % t .5ross leg raising test % t .,, 0t .0t .
7/24/2019 Lowbackpain Thai
12/36
September 17 ,200 12
1.3.&1.3.& /oint of tenderness/oint of tenderness ((............((............midline midline
paraspino!s ..paraspino!s ..
iliac crest iliac crest
greater trochanter greater trochanter
1.3.1.3. m!scle spasmm!scle spasm ((..............((............1.3.61.3.6 long tract signslong tract signs ((............ ((.......... ,abinski ,abinski
clon!s clon!s
hyperrefle7ia hyperrefle7ia
7/24/2019 Lowbackpain Thai
13/36
7/24/2019 Lowbackpain Thai
14/36
7/24/2019 Lowbackpain Thai
15/36
September 17 ,200 15
(1,3 ,$(1,3 ,$((
#!$%#$#!$%#$ lower motor ne!ron lesionlower motor ne!ron lesion !"!"
7/24/2019 Lowbackpain Thai
16/36
September 17 ,200 16
Str"!%*t /e% r"!+!&% te+tStr"!%*t /e% r"!+!&% te+t
4('& !!!#( 0 ,4('& !!!#( 0 ,'& +&.#()$'0'& +&.#()$'0!'&($!.(!#'& "$!'&($!.(!#'& "$
#!%! ,*.%!!$!%! ,*.%!!$&!#0#$#'& ##!#0 #$#'& ##'&((#!'& #'&((#!'& #!0! + "+/!0! + "+/
#)!"0! #5$(#)!"0! #5$(#!0!! # !$0#!0!! # !$0#.%!!%!$%!#( 1##.%!!%!$%!#( 1#!.!.
7/24/2019 Lowbackpain Thai
17/36
7/24/2019 Lowbackpain Thai
18/36
September 17 ,200 18
-"1-"1 Str"!%*t /e% r"!+!&%Str"!%*t /e% r"!+!&%te+tte+t
,!(+0+.,!(+0+.006$ #$'&6$ #$'&" ,!" ,!((&er'e rt !rr!t"t!&&er'e rt !rr!t"t!& $$*"m+t!&% m+./e +p"+m*"m+t!&% m+./e +p"+m !%!!%!
"+0"+0 7070 6 6
!(#(#!(#(# /mb"r/mb"r$$ +".r!/!". !&t+".r!/!". !&t
7/24/2019 Lowbackpain Thai
19/36
September 17 ,200 1
22 I&'e+t!%"t!&I&'e+t!%"t!&
B/$ te+t CBC , 9S ,B/$ .*em!+tr#B/$ te+t CBC , 9S ,B/$ .*em!+tr#
:-r"# P/"!& L-S +p!&e AP, L"ter"/:-r"# P/"!& L-S +p!&e AP, L"ter"/
L-S b/!;eL-S b/!;e
7/24/2019 Lowbackpain Thai
20/36
7/24/2019 Lowbackpain Thai
21/36
September 17 ,200 21
%1(#$%1(#$
0#$ !1%!0#$ !1%! #!$%#$+!$%#$+& !"!"
#!$%#!$% ,,
+1+1 %11'%11' ",4--!",4--! ,,
#!#!
7/24/2019 Lowbackpain Thai
22/36
September 17 ,200 22
%1+-%1+-L-SL-S
+p!&e AP ,L"ter"/+p!&e AP ,L"ter"/ #!#! 5050
#()#() ,,
/,&/,&!! ,, /,#)/,#),, ## ,,'&!'&!
,, #!#! 33 #$!#$! ,,
!"!" !1%! #$ ,$!0 #(! 0!1%! #$ ,$!0 #(! 0
7/24/2019 Lowbackpain Thai
23/36
September 17 ,200 23
%1+-%1+-L-SL-S
+p!&e Ob/!;e '!e+p!&e Ob/!;e '!e C"+eC"+e Sp&$#//#+!+Sp&$#//#+!+ ""
Sp&$#//!+t*e+!+Sp&$#//!+t*e+!+
(-(- p/"!& L-S +p!&ep/"!& L-S +p!&e
7/24/2019 Lowbackpain Thai
24/36
September 17 ,200 24
%1+-%1+-L-SL-S
+p!&e 9te&+!& '!e+p!&e 9te&+!& '!e1.1. !$%' !!(0!$%' !!(0
$$
2.2. $(!$(! 0S spine0S spine !'%!&$!'%!&$$$ %!&$$%!&$$3.3. ,(%$#$!,(%$#$! 0 Spine0 Spine
7/24/2019 Lowbackpain Thai
25/36
7/24/2019 Lowbackpain Thai
26/36
7/24/2019 Lowbackpain Thai
27/36
September 17 ,200 27
33!(5!(5 (( ?!"%&+!+ )?!"%&+!+ )3131 0#"!0#"!(!$!p"t*!. b". p"!&)(!$!p"t*!. b". p"!&)
(#)!#5! $#$% +#!(#)!#5! $#$% +#! 77 +$ +$#)!#$%#)!#$%
3232 #(!#(!(( '!+.er%e&!. b". p"!& )'!+.er%e&!. b". p"!& ) #! #!#! #! ,,$!4$!4 ,, #!#! ,,
#$#$3333#((#(( ( P+#.*%e&!. b".( P+#.*%e&!. b".
p"!& )p"!& )
7/24/2019 Lowbackpain Thai
28/36
7/24/2019 Lowbackpain Thai
29/36
7/24/2019 Lowbackpain Thai
30/36
September 17 ,200 30
99 #$!#$!
8989 ")$5$54"")$5$54" EFGEFG$!4%$!4%DFGDFG !!
:9:9 (!'$%''(1'(1)(!'$%''(1'(1)!"!"
D9D9 ("'(("'(
E9E9 (%$% %"'(()(%$% %"'(()!'$%'!'$%'
7/24/2019 Lowbackpain Thai
31/36
%%
7/24/2019 Lowbackpain Thai
32/36
September 17 ,200 32
%' 1%' 1 LL
B". P"!&B". P"!& (!'$%')"$$4$(!'$%')"$$4$
)'$()2$)'$()2$ ("'(("'(
JFK KLMN=JFK KLMN=$,$,
7/24/2019 Lowbackpain Thai
33/36
7/24/2019 Lowbackpain Thai
34/36
7/24/2019 Lowbackpain Thai
35/36
September 17 ,200 35
2.2. #"&'((!$$!." +!("#"&'((!$$!." +!(" $! (%-$! (%-
))% S0% S0*"#.$!) (!'$%'*"#.$!) (!'$%'$5$5%% 1",$5 *""$5$541",$5 *""$5$54 44 $!4$!4
1"!(0*1"!(0* 2323 $!4*"$!4*" 0S spine $/ lateral0S spine $/ lateral1",!"$$5$54 *"1",!"$$5$54 *" 0S spine0S spine
$/ lateral$/ lateral $ $ 'bli=!e'bli=!e *('("+,*('("+,$%!&$%!& pars interartic!larispars interartic!laris 1"#1"# 7ray7ray *"$5$54*"$5$54 44 $!4$!4!$5'!$5' 1212 $!41"!(0 !&*$!41"!(0 !&* 5hronic5hroniclow back painlow back pain
7/24/2019 Lowbackpain Thai
36/36
September 17 200 36
33 '&0'&0 ,, #$#$ ,, !1%!!1%!
(( SL SL' 0"' 0"#!$%#$(#$#!$%#$(#$ ,, L-S +p!&e APL-S +p!&e AP@/"ter"/ , C: PA@/"ter"/ , C: PA "./"#5#$"./"#5#$",(#$!",(#$!
44 '&0'&0 ,, #$#$ ,, !1%!1%! 88! 88(( SL SL' "' "#!$%#$ (#$#!$%#$ (#$ ,, L-S +p!&eL-S +p!&e
AP @/"ter"/AP @/"ter"/
+-+- L-S +p!&eL-S +p!&e "1&! "1&! 1#!!/#)!#!$%&!1#!!/#)!#!$%&!