TUTORIAL B5 BLOCK 4

MEDICAL FACULTY OF SRIWIJAYA UNIVERSITY

MEMBERS: Damai Trilisnawati (54081001098) Helda Sari Sianturi (540810001105) Yetha M.A. Mukiat (54081001061) M. Tauhid Lestarrio (54081001094) M. Indra Hadiwijaya (54081001091) Indah Lestari (54081001082) Maretha Winny Astria (54081001079) Nevinia Ann A/P Robert (54081001110) Lavin Raj Narainan (54081001120) Laurensius Agus Winarto (54081001082)

TERM CLARIFICATION: Lower back pain: the feeling of physical

suffering Radiates down: spread outwards from a

central point in down Lumbago: pain in the lumbar or loin region,

of any cause or description Sciatica: pain in the lower back and hip

radiating down the back of the thigh into the leg

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Housekeeping: work of managing a household

Tingling sensation: a sensation as of repetitive moving pin pricks, caused by cold or by striking a nerve or a result of various disease of the central or peripheral nervous system

MRI examination: Magnetic Resonance Imaging

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Neorologist: doctor who studies and treats disease of the nerves

L5 level: the fifth lumbar Lower extremitas: parts of your body furthest from

then centre especially feet Supine: lying on the beck or with the face upwards Prolapsed of nucleus: downward displacement of

an organ or tissue from its normal position, usually the result of weakening of the supporting tissue

Ex-weight lifter: former of weight lifter.

PROBLEM IDENTIFICATION:

Rasunan, an ex-weight lifter, 54 years complains of lower back pain

the pain is worsened by coughing, lifting, after standing or sitting still for an hour or more

He suffered from lumbago and sciatica the doctor told him that he was not quite

sure what cause of pain

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The patient complains of severe pain when his right leg is raised by the clinican

The different result between doctor’s diagnosis and MRI examination

MRI confirm the diagnosis as prolapsed of nucleus proposes at L5 level.

PROBLEM ANALYZE: What system and organ are get involved in

Rasunan case? What is the etiology basis of the pain? What is the characteristic of lumbago? What is the characteristic of sciatica? What is the correlation of ex-weight lifter

with low back pain?

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What is specific region of lumbago? What is relation between lower back pain

and his age? What is relation between complain and

neurologist diagnosis? What is mecanism of pain in this case? What is pathophysiological basis of the

pain?

HYPOTHESIS:

“Rasunan suffer of lumbago and sciatica because there is prolapsed of nucleus

proposes at L5 level”

LEARNING ISSUE:

HNP Lower back pain Lumbabgo and sciatica Nervous system Muscular system Skeletal system

SYNTHESIS: HNP (Herniation of Nucleus

Prosesus)Take of discus intervertebralis/prolapsus discus:Behind the theoritis all of back bones (vertebrae) can experience prolapsus discus intervertebralis Hernia Nucleus Pulposus (HNP), but usually increasing in border lumbalis IV level-lumbalis V level, and lumbalis V-sacralis I.

CONT... Etiology:

Raise the heavy load with the back curve, that should have been straight.

Mecanism:Arch of the back into front will cause constrict front region of back bones, whereas back region is stretch, so nucleus pulposus will pushed to the back.Prolapsus discus intervertebralis, just that pushed in the back is make pain because in back vertebrae region there is fibrous and the root of spinal nervous, and when pushed by prolapsus discus intervertebralis will make pain in back region, moreover can make paralyzed in extremitas inferior region.

CONT... Symptom:

Pain in back extremitas inferior, can spread until buttocks and thigh

Pain can dirrect emerge after disagreement or several next hour moreover can several next day. If the pain exist in back and hip region called Lumbago, when the pain until buttocks called Isias.

The pain can like stiffs or stabbed that go on continue, and when used will felt more pain, so sometimes who suffer don’t want move his/her back as if locked. Cough or sneeze can increase feel of the pain, such change of posture from sit to stand is the big torture.

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Treatment:- Natural treatments- Doctor’s treatment: conservative theraphy and

operative.

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Lower Back Pain (Lumbago)Lumbago is the term used to described general lower back pain. The excat cause oe the lumbago/back pain is often unknown. The back pain can come on after lifting thimgs, or overuse or it may come on without previous exercise or training.

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Symptom: Pain in the lower back which does not radiate

down the legs Stiffness in the back especially in the morning

A poor posture or ‘S’ shape in the spine (scoliosis) Treatments:- Rest 9in bed if it is really severe). The psoas

position is often the most confortable position- Apply heat ar have hot baths- See a sports injury specialist or doctor who can

make an accurate diagnosis of the problem.

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Lumbago often goes only to come back again later. If this happens you should consider a full rehabilition and back education programme.

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SciaticaSciatica is pain within the pathway and distribution of the sciatic nerve. The sciatic nerve is formed by nerves from the spine at the junction of the lumbar and sacral regions. The nerve passes from the spine into the pelvis then into the buttock, posterior (back of) thigh and down below the knee.Below the knee the nerve divides into two branches, one going through the posterior (back) calf down the inner side of the ankle, and a second division goes through the outer side of the calf around the top of the ankle and foot to the toes.

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The important features of sciatic pain are that it goes below the knee, and it is associated with neurological symptoms. The neurological symptoms include a sharp or burning character to the pain; changes in sensation such as tingling, pins and needles or numbness; and association with weakness.

The branches of nerves from the spine that make up the sciatic nerve are the low lumbar and upper sacral nerves. These branches give sensation to the front, the outside and the posterior (back) part of the leg below the knee.

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They also give strength to the muscles that pull up the ankle and the toes, turn the foot to the outside and give strength to the calf muscles.The nerve roots involved also supply the ankle reflex. The most common nerve roots that are involved in sciatica are the L5 (Fifth Lumbar) nerve root and the S1 (First Sacral) nerve root.These differing nerve distributions result in differing areas of numbness and weakness. The L5 nerve root (so named because its origin is from the lower part of the 5th lumbar vertebra) is often associated with numbness that goes through the top of the foot to the great toe.

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The S1 nerve root (named because it exits the spine below the first sacral vertebral segment) is associated with sensation that goes through the outer aspect of the foot to the little toe. Loss of function of the S1 root will be associated with numbness in this area.

It is important to understand that sciatica is pain that goes through the course of the sciatic nerve and this means that it should go below the knee. Many people mistake buttock pain for sciatica.

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It is true that the sciatic nerve goes through the buttock but many other causes of pain from the spine may be referred to the buttock and the presence of pain in the buttock alone does not imply irritation, inflammation or compression of the sciatic nerve.Sciatica occurs most frequently in people between 30 and 50 years of age.

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Organ of Lumbago and SciaticaOrgan of lumbago and sciatica is columna vertebrae.

Columna vertebrae consist of:- Vertebrae cervicalis (7)- Vertebrae thoracalis (12)- Vertebrae lumbalis (5)- Vertebrae sacralis (5)- Vertebrae coccygea (4)Columna vertebrae that participate in lumbago and

sciatica is vertebrae lumbalis 4-5 and vertebrrae sacralis 1.

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Muscular SystemThe muscle that participate in lumbago and sciatica are:

L4: m. Tibialis anterior, m. Quadrisep. L5: m. Extensor hallucis longus, m. Extensor

digitorum longus. S1: m. Gastrocnemeus, m. Soleus.

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Nervous SystemThe nerves that participate in lumbago and sciatica are:

- Sciatic nerve- Spinal nerve

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