What Questions Do You Ask A Low Back Pain Patient - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 5 ต.ค. 2021
- Dr. Ebraheim’s educational animated video describes what questions to ask the patient with low back pain symptoms.
Check my new book, Synopsis of Orthopedic Emergencies on amazon. Here is the link.
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When the patient comes to you for evaluation of low back pain, the first question that you want to ask is if the patient has any bladder or bowel problems. You on a separate low back pain or acute low back pain from cauda equina. Cauda equina syndrome is an orthopedic emergency! It needs to be diagnosed early and treated by surgery early. Make sure that you do not miss cauda equina syndrome. Ask the patient about any bowel bladder or bowel changes. If there is any concern, then you need to get a stat MRI with a wet or stat reading.
Acute low back pain or low back pain with sciatica radiating to the lower leg and to the foot.
Both conditions are initially treated conservatively for at least 6 weeks by:
Physical therapy
Anti-inflammatory medication
Limited activity (as guided by the pain)
Treat the condition conservatively even if there is a big disc herniation on the MRI-wait at least 6 weeks.
Acute Low Back Pain
90% of patients will have symptoms resolve in 1 month.
Smoking, depression, and vibrations will increase the incidence of low back pain
Intradiscal pressure (IDP) changes with different body positions. The lowest pressure is measured while the patient is lying supine. The highest IDP is measured while the patient is sitting, leaning forward and holding weight. If the patient is experiencing low back pain and there is history of cancer, you need to get an x-ray and MRI, especially if the pain occurs during rest and at night. In case of a renal tumor, you will probably need to do arteriography and embolization of the spinal lesion. The spine is a common location for metastatic tumors. Metastases occur in the vertebral body and goes to the pedicle. Loss of about 30% to 40% of the bone marrow should occur before we can detect the lesion on x-ray. Loss of the pedicle bone will give us a "weak sign.”
Infection will occur within the intervertebral disc space. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels will be elevated. Only 50% of the cases will have fever and less than 50% will have an elevated white blood cell count (WBC). Get a blood culture (positive in about 24% of cases). Get an MRI and give antibiotics as guided by biopsy, culture and sensitivity. If the patient has an epidural abscess, you will do surgery, especially if there is a deterioration of the neurological function. If there is an infection post-operatively, you can diagnose it with a high C-reactive protein (CRP).
Osteoporotic spine fracture
Osteoporotic bone is at risk of fracture at the wrist, of the spine, and then the hip. If you have an osteoporotic spine, you need to treat it before leads to a hip fracture later on. One fracture of the spine will lead to more spine fractures. After 1 year of treatment with medication, the incidence of vertebral fracture is decreased by 60%. After 2 years incidence of vertebral fracture is decreased by 40%.
When you are dealing with a patient with low back pain:
Treat the patient conservatively.
Do not get an x-ray in the first 4 to 6 weeks unless there are some "red flags "such as:
Patient is older
Patient has a metastatic tumor/history of cancer
Infection is suspected
Patient has trauma
Osteoporotic fracture due to steroid use
You may see an x-ray that looks like ankylosing spondylitis. Check the SI joint because ankylosing spondylitis starts in the SI joint. You may get HLA-B27. You will find that there are marginal syndesmophytes with diffuse ossification of the disc space without large osteophyte formation. Ankylosing spondylitis is different from Diffuse Idiopathic Skeletal Hyperostosis (DISH) which occurs in diabetics. Get an HbA1c test. Sydesmophytes are none marginal and have larger osteophytes. There is diffuse idiopathic skeletal hyperostosis (DISH), which will have flowing ossification along the anterior lateral aspect of the least for continuous vertebra. DISH is not ankylosing spondylitis. You are going to get an MRI of the spine at a certain point, however you need to start first by getting x-rays.
MRI may be a problem.
There are abnormal MRIs in asymptomatic patients (there are false positives)
35% patients less than 40 years of age
90% positive MRIs in asymptomatic patients over 60 years of age
MRI with gadolinium dye
Gadolinium will differentiate a disc from a scar
Both granulation tissue and the recurrent disc could look-alike on routine MRI
If there is a vascular enhancement then it is a granulation tissue and you will need to sit tight and not do surgery
If there is no enhancement, then it is a recurrent disc and it is avascular, consider surgry if indicated
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I'm not a medical student or doctor, but I found this extremely helpful! Finally, everything I need to know about lower back pain in one detailed video. Thank you!
I am a physiotherapy student and your videos have been very helpful in aiding my understanding. Amazing and well explained . Jazakallah khair
I've been struggling with bowel and bladder incontinence since my back injury occoured. I really appreciate you uploading this educational video.
So have I but I didn’t realise that it could affect the bowel and bladder until I watched this video. Thank you so much I’ll contact a doctor asap. It’s been over a year so there’s no hope left now. 🇬🇧
Plz prepare for total hip replacement full
Following your channel since last 10 years and I can proudly say that you are the best in terms of animation and explanation in the perfect strecth!
I'm SCI C5/SL from motorcycle accident I feel all pain from back neck, both muscle arm going the fingers and right side lower back pain going to my foot and I feels all of that right now and my SCI problem running 2 years now. 👍👍👍👍👍
You are the best at explaining
plz tell the exercise
Sir please guide me about best app for artho
Good, thanks
1- Inflammatory or mechanical LBP ?
Hello Sir, I has a disktomy surgery in my lower back L4 & L5.. it's been 5 yrs, I have able to walk slowly.. but I have lost sensation of bowels, urine & erection as well since my surgery. Is there any chance of recovery.. it's been more than 5 yrs.
Thx
please give me advise Doctor
Thank you! Your video helped me.
Good day sir. May i ask about low back pain! Last july this year my husband was accident in his work hes body down in solid rock with a metal he goes to hospital and the doctor check hes body Xray CT SCAN and ultrasound. The laboratory test result is okay because theres no fracture in his spinal but theres a small wounded near in his spinal that we need to stitch after 3days the doctors decided to take my husband to my home to rest for recovery but my husband said hes low back always pain until now and hes right of his low back is numb until now After 4months they same feels the low back will feel pain and their right foot will not able to up! The firtst follow up check up doctors give a medicine for pain reliever it was okay because its little effectively but the second follow up check up is the same result of the first. I hope the situation can be answered. We need your opinion thankyou doc.
Thank you soo much
I feel a momentarily stab in a very certain spot in my lower left back when I do certain stretches..
I have for about 4 months (Doctor next week).
Yet sometimes the stabbing feeling is in the spot itself and that's it and sometimes when I am trying to do a certain stretch which cause that stabbing feeling I feel kind of stretch behind/side my thigh then to the glute a little bit (depend on the kind of stretch) and then to the spot in my lower back (left only).
Sciatica or Disc???
In rare occasions I feel it when i step on my left heel and it radiates to the stabbing spot in my lower back (left).
That spot isn't in the spine in the middle, it is about 1CM to the left.
Not sciatica. May or may not be disc
Thank you sir.
I have back pain but anytime I do something strong it hurts
This channel is gaining subscribers at a rapid pace. Love it.
Perfect
My doctor has never asked any of these questions but I finally forced her to to xray which shows cervical foraminal stenosis at c2-c3. I have unsteady gait, tingly numb index and pinky finger both hands especially when I sleep. I have to keep my arms completely straight. I get dizzy when I bend over and come back up. The left side of my neck feels always hot and hurts. My right scapula has tightness and pain and sometimes I get sharp and burning pain right under my arm. I have almost constant low back pain that can get better with gettin up and moving around but sometimes I feel like the back of my left hip locks when I walk too far, standing doing dishes also produces that tight locking pain. I have inflation of Achilles insertion and calcneal bone spur. I never get relief from rest, I wake stiff and tight and it relieves but pain doesn't. I asked my doctor for sacroiliac joint xray and she said would be included with lumbar so she didn't need to ask for it. But my lumbar xray mentioned nothing of sacroiliac. I'm at a loss and in chronic pain, what can I say to her for her to help me?
Don’t say anything.
Find a better Dr!
You are Great 👍
Thanks sir
hello doc Nabil, where is your location? you are here in uae?
Amazing
Exelente explicación ,el problema es que le entiendo muy poco x el idioma
thank you doc! I am a physical therapist assistant who believes in manual work and hands techniques. I just opened up my own physical therapy and I want to continue learning so I can be ready for whatever my clients need!
How can you open up your own physiotherapy if your a physiotherapy assistant?
i have lower back pain for last few months. i drink fresh lemon juice 1 cup in the morning and added lemon slices in my water to consume all day ~3 liters. i notice pain reduce a lot.
Hvala profesore, veoma koristan video
Informative!
Lower back pain, weakness in my legs which has reduced my stride
Developed foot drop
@Tim Bo yes I did and no issues found
Hola Doctor, nos gustaría ver sus videos en español, sé que se lo pedimos mucho, ojalá algún día lo pueda hacer, muchas gracias!
Good sharing 👍
Nice👌
Tôi đã phẫu thuật thoát vị đĩa đệm cột sống lưng, nhưng bệnh không khỏi, xin giúp tôi ( Vietnam)
Lower back pain with pain in right calf muscle that goes away immediately with rest
I have a back pain so what should i have to do
Just learn youself...
Sir ye kase thik hoga hindi me bataiey
I had an MRI and I have a C compressed disk and I think it is going to be permanent. I had my accident when I was 25 and now I am 33.
Come and listen
Best
Proszę😫🙏🙏💓 o tłumaczenie na język Polski.
ممكن ترجمه
# 4 that my pain problem ...
U r perfect
Español traducirlo
Very clear and informative. Jazak allah kher.
Knee pain
Bitte mit deusche Übersetzung Danke
💮
انا في خطر
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Donon Pairon ki heel Mein Dard bahut jyada hai
Hi from united states of albania 😉
Na cmendi kjo dhimbje
A Ka ndo ilac per kete
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