BACKACHE

PREVENTION AND CURE

DR SUJOY BHATTACHARJEE MS (ORTHO) ,FMIS(USA) Fellow-Ship Joint Replacement Surgery GERMANY SR Consultant & Chief Joint Replacement Surgeon

Back Pain
2nd most common cause for office visit 60-80% of population will have lower back pain at some time in their lives Each year, 15-20% will have back pain Most common cause of disability for persons < 45 years 1% of US population is disabled Costs to society: $20-50 billion/year

The Spinal Column

7 cervical (neck) vertebrae

12 thoracic (middle back) vertebrae

5 lumbar (low back) vertebrae
Sacrum (fused vertebrae)
Coccyx (tailbone)

The Spine - Detailed View

Spinal Cord

Vertebra
Facet Joint Disc

Inner - disc material pressing on nerve Ruptured Disc Nerves

Back Injury Risk Factors - Acute

Acute (traumatic) back injury may occur due to: slips, trips and falls; auto accidents; sedentary lifestyle (with occasional lifting); heavy and/or awkward loads; improper lifting technique.

Back Injury Risk Factors - Chronic

Chronic back injury may result from poor posture and/or improper lifting technique combined with repetitive lifting. Additionally, genetics and overall physical fitness may affect spine health.

Risk Reduction Engineering/Design

You can design a safer lifting environment by: Avoiding very high and very low object placement; Reducing object weight and size; Providing handles; Eliminating the need for twisting motions; Eliminating bending and stooped postures; and By providing mechanical assistance.

Risk Reduction - Lifting Tips

When lifting, you can substantially reduce your risk of low back injury and pain by: Keeping the object close to you; Bending your knees;

Maintaining your lumbar curve (bend knees and stick buttocks out);
Not twisting or bending sideways; Avoiding rapid, jerky movements; and

Asking for assistance with heavy and/or bulky loads.

Risk Reduction at Home

Maintaining a neutral spinal posture when stooped (e.g., when shaving, brushing teeth, bathing children, repairing cars, shoveling, etc.) may reduce your risk of back injury and discomfort. Planning your lifts, getting assistance, and using mechanical advantage are examples of risk reduction strategies.

Backache
WHAT CAUSES BACK PAIN? Disc injury Degenerative disc disease.

Backache
RUPTURD DISC: A ruptured disc is an injured or damaged disc that leaks out watery jelly (called nucleus pulposus) from the center of the disc. This leakage reduces the shock absorber effect and sometimes the jelly presses against a nerve and causes pain, primarily leg pain.

PROLAPSED DISC
The phrase "a slipped disc" is used very commonly and indeed at some time of other this diagnosis has been blamed for producing almost every form of acute back pain. There are two major errors in this. All discs do not and cannot slip. What does go wrong and may be called a "slipped disc" is much less frequent than previously thought

Backache
DEGENERATIVE DISC DISEASE As discs degenerate, they lose their water content and height, bringing vertebrae closer together. The nerve openings are consequently narrowed and the added pressure from the disk can pinch a nerve causing back or leg pain.

Backache
PROBLEMS The Neck The Mid Back The Lower Back Hips Base of the Spine

Backache
NECK A slipped or prolapsed disc in the cervical spine could result in a severe pain in your shoulder, arm or hand. Small movements may make the pain worse. accompanied by numbness or tingling in the fingers

Backache(CHART)
MID BACK: Back pain that becomes worse after sitting in one position for a long time may be caused by poor posture or by a badly-designed chair. Stress, anxiety and emotional worries can lead to muscle tension which results in aches and pains in the back. This is one of the MOST COMMON causes of back pain - probably affecting as many as eight out of ten sufferers.

Backache
TYPES: Sudden onset Continuous Exacerbated on

1. Exercise 2. Passing urine 3. Movement/ cold weather

Backache
SUDDEN ONSET PAIN: If your pain started after a trivial movement such as tying up your shoe laces or turning over in bed - it may be a result of a slipped disc or a joint problem in your spine. Pain going down one or both legs, or numbness or tingling in one or both legs, then you may be suffering from sciatica

Backache
CONSTANT PAIN: Radiates round the chest - a fracture caused by osteoporosis of thin bones. Accompanied by discomfort when passing urine and/or blood in your urine - kidney infection/Stone. In the middle of the back that is made worse by eating and accompanied by indigestion stomach ulcer.

Backache
CONSTANT PAIN (Contd.): Low back pains that are accompanied by gynecological symptoms (discharge, bleeding etc.) may suggest a gynecological cause - such as period pain.

INVESTIGATIONS:
MRI (Magnetic Resonance Imaging) scan is the most common test used to look at the spine. This allows us to view not only the bones of the spine, but also the nerves and disks. Slices can also be taken across the spine, giving a cross sectional view. The MRI scanner allows us to see the nerves and disk quite clearly. No special dyes or needles are necessary.

MRI

MRI

The MRI scan is, perhaps, too good at showing the anatomic details of the spine.
growing body of evidence suggests that not all abnormalities that show up on the MRI scan are really the cause of the individual patient's problem. Abnormalities, such as bulging disks, show up frequently in normal volunteers undergoing MRI scans-people who have never had any problem with their back.

Backache
MANAGEMENT Conservative Surgery

Backache
CONSERVATIVE MANAGEMENT: Good posture Bed rest on hard bed Exercises Stress therapy

POSTURE:
The neck has a slight natural curve, which sits on top of the two curves in the middle and lower back. Correct posture maintains all three curves and prevents undue stress and strain by distributing body weight evenly

STANDING POSTURE In correct, fully erect posture, a line dropped from the ear will go through the tip of the shoulder, the middle of the hip, the back of the kneecap and the front of the anklebone.

SITTING POSTURE When sitting in any position, the three back curves need to be maintained. If you cannot sit without slouching forward or backward, you need to support yourself with hands and arms or lean against a wall or chair back.

SITTING POSTURE

SITTING POSTURE:

LYING POSTURE:

Avoid propping head or upper body up on an arm and hand. Head should remain relaxed. Legs should be together.

Backache
EXERCISES:

Cat Back

Fetal Position Arm exercises

 Alternate Leg Slides

Alternate Leg Raises

RELIEVE STRESS
Yoga Meditation

PAIN CLINICS
ADVANCED TECH PAIN MANAGEMENT

POPULAR IN USA & WESTERN WORLD

REDUCE WORK DAY LOSS

PAIN CLINIC
MINIMAL INVASIVE PROCEDURES

DAY CARE COST EFFECTIVE

NO COMPLICATIONS IMMEDIATE RELIEF

 ACUTE PAIN NECK, BACK,

CHRONIC PAIN ACCIDENT ---CHEST INJURY

INDUSTRIAL TRAUMA

SURGERY
Only considered if: Conservative management fails Patient develops neurological deficits (weakness, numbness, change in reflexes)

Diskectomy
The removal of a herniated disk to relieve pressure on a nerve root Window in the laminaretract nerve-removal of herniated disc material-healing by scar tissue

Laminectomy
Derived from lumber (lower spine), lamina (part of the spinal canal's bony structure) and -ectomy (removal). The operation is performed to relieve pressure on one or more spinal nerve roots

Osteoarthritis of The Knee

I. Overview
Epidemiology Definition Risk Factors

II. III. IV. V.

Clinical Approach to Knee Pain Differential Diagnosis Diagnosis of Knee OA Management

Lifestyle Medical Surgical

Diagnosis of Knee OA

Management: Lifestyle
Varus (bowlegged) vs Valgus (knock-kneed)

G2 Unloader Brace

Management: Medical
Glucosamine/Chondroitin Acetaminophen NSAIDs Cox-2 inhibitors Opioids Intraarticular injections
Glucocorticoids Hyaluronans

Management: Surgical
When to Refer
Knee pain or functional status has failed to improve with non-operative management

Types of Procedures
Arthroscopic Irrigation Arthroscopic Debridement High Tibial Osteotomy Partial Knee Arthroplasty Total Knee Arthroplasty

Management: Surgical
High Tibial Osteotomy
Indication:
Unicompartmental arthritis Genu varus or valgus Realign mechanical axis Age < 60yo < 15 degrees deformity19

Management: Surgical
Total Knee Arthroplasty
Indication:
Diffuse arthritis Severe pain Functional impairment

Pain relief > functional gain ACL sacrificed PCL also may be sacrificed Prosthesis 25-yr survival: 90% 21

THANK YOU