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Low Back Pain and Osteoarthritis

Initial Classification of Acute Low Back Symptoms

Sciatica. Back-related, lower limb symptoms suggest lumbosacral nerve root compromise.

Nonspecific Back Symptoms occur primarily in the back and suggest neither nerve root compromise nor a serious underlying condition.

Potentially Serious Spinal Conditions. Tumor, infection, spinal fracture, or a major neurologic compromise, such as cauda equina syndrome.

In the absence of signs of dangerous conditions, special studies are not required since 90% of patients will recover spontaneously within 4 weeks.

Nonmechanical Causes of Low Back Pain

Rheumatologic Disease. Polymyalgia rheumatica, fibrositis, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, enteropathic arthritis.

Infection. Vertebral osteomyelitis, diskitis, epidural abscess

Tumor. Osteoma, multiple myeloma, skeletal metastases.

Endocrinologic and Metabolic Disorders. Osteoporosis with fracture, osteomalacia.

Referred Pain. Abdominal aortic aneurysm, kidney stone, pyelonephritis, silicone, breast implants.

Markers for Potentially Serious Conditions  

Clinical Evaluation of Low Back Pain

Assess present symptoms, limitations, duration of symptoms, and history of previous episodes of pain or injury. Symptoms may include constant or intermittent pain, numbness, weakness, and stiffness located primarily in the back, leg, or both.

Ascertain results of any previous testing or treatment.

Sudden onset of pain is most likely to arise from a disk, while pain with a slow onset or with frequent, milder recurrences, is more likely to be ligamentous in origin.

Certain body positions or low back pain, back pain, sciatica, osteoarthritis movements may exacerbate or relieve pain. Determine the time of day when pain appears. Herniated disk pain causes great difficulty sitting or bending, while pain of ligamentous origin causes inability to remain in any position for