Case:03 Low Back Pain: Difference between revisions
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31 year old male builder referred with two months of low back pain starting after he picked up a 30kg block and twisted and felt a โpopโ in his lower back causing immediate pain | 31 year old male builder referred with two months of low back pain starting after he picked up a 30kg block and twisted and felt a โpopโ in his lower back causing immediate pain | ||
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VAS 4-5 to 7/10 | VAS 4-5 to 7/10 | ||
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*On 22/10/19 he was lifting & throwing concrete into skip bin. Picked up a 30kg block and twisted and felt โpopโ in his lower back & immediate pain | *On 22/10/19 he was lifting & throwing concrete into skip bin. Picked up a 30kg block and twisted and felt โpopโ in his lower back & immediate pain | ||
*Worked on and that evening he had significant low back pain | *Worked on and that evening he had significant low back pain | ||
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*Canโt comfortably hold 7 month infant | *Canโt comfortably hold 7 month infant | ||
*Poor sleep โ best on side pillow between knees | *Poor sleep โ best on side pillow between knees | ||
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Examination= | =Examination= | ||
*An engaging man not obviously in pain | *An engaging man not obviously in pain | ||
*Could reach middle of shins; L. ext. hurt | *Could reach middle of shins; L. ext. hurt | ||
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*Blunting of pin prick dorsum right foot | *Blunting of pin prick dorsum right foot | ||
*Antalgic weakness | *Antalgic weakness | ||
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Imaging= | =Imaging= | ||
[[File:Interspinous_Oedema_MRI.jpg]] | [[File:Interspinous_Oedema_MRI.jpg]] | ||
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Ask for a T2 fat suppressed Dixon coronal. Corroborate the coronal ISO in the sagittal plane. Have the sequence start posterior to the spines. A STIR will suffice but less resolution }} | Ask for a T2 fat suppressed Dixon coronal. Corroborate the coronal ISO in the sagittal plane. Have the sequence start posterior to the spines. A STIR will suffice but less resolution }} | ||
}} | }} | ||
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Management= | =Management= | ||
[[File:Interspinous_Oedema_Fluoroscopic_Injection.jpg]] | [[File:Interspinous_Oedema_Fluoroscopic_Injection.jpg]] | ||
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*A mixture of 40 mg Kenacort A and 0.5 mL 0.75% Ropivacaine was infiltrated into the L4/5 interspinous space. | *A mixture of 40 mg Kenacort A and 0.5 mL 0.75% Ropivacaine was infiltrated into the L4/5 interspinous space. | ||
*No immediate complications. | *No immediate complications. | ||
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Follow up= | =Follow up= | ||
'''24th January 2020ย (14 weeks post injury)''' | '''24th January 2020ย (14 weeks post injury)''' | ||
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His straight leg raise was increased on the right to approximately 80 degrees limited by hamstring tightness, and on the left to 70 degrees limited by hamstring tightness. | His straight leg raise was increased on the right to approximately 80 degrees limited by hamstring tightness, and on the left to 70 degrees limited by hamstring tightness. | ||
There was no tenderness to palpation in his buttocks or spinous and interspinous processes today. | There was no tenderness to palpation in his buttocks or spinous and interspinous processes today. | ||
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Related Articles= | =Related Articles= | ||
*[[Interspinous Oedema]] | *[[Interspinous Oedema]] | ||
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[[Category:Case Histories]] | [[Category:Case Histories]] |