Diseases, Disorders information

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So, in summary, I know it’s a lot of material pretty quickly, but when you take a history, you want to know about the character and the nature of the pain, what makes it better, what makes it worse, what medications have worked, which haven’t, do you have any neurologic findings, is it back pain, leg pain, and do your quick and dirty assessment. Flexion, extension, check the Trendelenburg maneuver, have them heel and toe walk. If it’s mechanical, brief period of bed rest followed by active physical therapy, pretty much as soon as the patient can tolerate it. If it’s disc herniation, sciatica, neuropathic pain, neurologically intact, maybe an epidural, maybe an oral steroid, but certainly off to physical therapy as soon as possible. If there is a neurologic deficit or the acute cauda equina syndrome, that is obviously an emergency and needs to be referred pronto. Deformity – you pretty much refer those when you see them, unless it is a spondylolysis in a gymnast which can be treated with a brief period of bed rest. Spinal stenosis, making the diagnosis on the basis of history, of neurogenic claudication and physical examination showing a flexion preference, again, perhaps epidural therapy, that is the study hot off the presses, maybe physical therapy, flexion distraction which is the new thing that is being evaluated, tumor atypical mechanical features that will be referred, infection, risk factors, atypical features and refer.