Examination of the Low Back Pain Patient
CLINICAL EVALUATION Focused history and physical examinations are fundamental elements in the assessment of low back pain. They are especially helpful in the preliminary classification of acute LBP into one…
Osteoporosis
Rotation. Place one hand on the pelvis and the other on the opposite shoulder. Rotate the pelvis and shoulder posteriorly and repeat on the other side; note any asymmetry in…
Low Back Pain and Effects of Lumbar Hyperlordosis and Flexion on Spinal Nerves
Lumbar hyperlordosis is 50% more accentuated with standing rather than sitting. This may cause nonspecific LBP localizing to somatic tissues (e.g., paraspinal muscles, facet joints) mediated by inflammatory mechanisms. In…
Lumbar Zygapophyseal Joint Back Pain
PATHOPHYSIOLOGY LZ joint pain primarily results from repetitive load-bearing strain accumulated over a lifetime; rarely, LZ joint arthropathy is traced to one inciting event. During midlife, cartilaginous changes accelerate, and…
Myofascial Factors in Low Back Pain
PATHOPHYSIOLOGY The development of MPS is often associated with postural derangements, such as muscle overload, dystonia, and fatigue. Postural abnormality (e.g., scoliosis) may reflect asymmetric extensor or flexor tone in…
Myofascial Factors in Low Back Pain (Continued): Posterior Abdominal Wall: Internal View
Rehabilitation approaches for MPS, including neuromuscular relaxation techniques, heat, or electrical therapy may also help. Physical treatments can also be used in the management of MPS. The “stretch and spray”…
Occipital Neuralgia
PATHOLOGY This uncommon neuralgia has various etiologies, primarily categorized as neurogenic, vascular, muscular, or osteogenic. Parenthetically, it is important to note that the C1 root, suboccipital nerve, is entirely motor…
Herpes Zoster
Herpes zoster complicates 10% of lymphomas, particularly Hodgkin disease. One in 25 active shingles patients harbor undetected carcinomas, lymphomas, or other diminished T-cell immunity pathophysiology, particularly immunosuppression with corticosteroid or…
Clinical Manifestations Related to Thalamus Site in Intracerebral Hemorrhage
Currently, a multistep pharmacologic approach is endorsed by some experts specializing in CPSP treatment; however, no trials are yet published, supporting a polypharmacy algorithm. Some pain physicians advocate tricyclic antidepressants…
Complex Regional Pain
PATHOPHYSIOLOGY This is enigmatic; one CRPS theory suggests that cutaneous innervation is altered post-traumatically. Human pathologic studies demonstrate reduced local nociceptive fiber density with aberrant hair follicles and sweat glands…
