A 42-year-old professional golfer complains of chronic back pain for many years. His
workup reveals that it is not the result of a degenerative disc
... [Show More] problem. His back “goes
out” about twice per year, and he is out of work for about a week each time. Which of
the following should the clinician advise?
Consider changing careers to something less physical.
Start on a daily low-dose narcotic to take away the pain.
Make an appointment with a neurosurgeon for a surgical consultation.
Begin a planned exercise program to strengthen back muscles.
In this case, the patient may benefit from a regular planned exercise program to
strengthen his back muscles and attempt to reduce the probability of future episodes of
back pain.
A 49-year-old female presents with low back pain radiating into the right leg,. An x-ray of
the lumbosacral spine is within normal limits. Which of the following diagnoses do you
explore further?
Compression fracture.
Herniated nucleus pulposus.
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Bedrest.
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Osteoarthritis.
A plain x-ray will not show a herniated nucleus pulposus or a muscle strain. It will show
spondylolisthesis, scoliosis, osteoarthritis, and spinal stenosis. Note that x-rays of the
spine are not indicated in low back pain unless the cause of the pain is thought to be
bony in origin or traumatic in nature or there is a need to rule out systemic disease.
In assessing the skeletal muscles, the clinician turns the patient’s forearm so that the
palm is face up. This is called:
Pronation.
Supination.
Abduction.
Eversion.
Turning the forearm so that the palm is up is called supination.
A conservative approach is recommended in the initial approach to the management of
low back pain. Which of the following would be an appropriate treatment plan for a 32-
year-old obese male (BMI 33) diagnosed with an acute lumbar strain?
A slipped capital femoral epiphysis (SCFE).
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Epidural Steroid Injections (ESI).
Surgery.
It has been proven that rest has little to no effect on the resolution of LBP. Patients
should do whatever activities are tolerable. Almost 90% of cases resolve within 1 to 6
weeks thus the initial management should include non-pharmacologic (massage, heat,
etc.), pharmacological (NSAIDs, short term use of muscle relaxants) and activity.
Surgery and ESI are not indicated in the initial management of LBP.
A 13-year-old obese (body mass index [BMI] above the 95th percentile) boy reports low grade left knee pain for the past 2 months. He denies antecedent trauma but admits to
frequent “horseplay” with his friends. The pain has progressively worsened, and he is
now unable to bear weight at all on his left leg. His current complaints include left groin,
thigh, and medial knee pain and tenderness. His examination demonstrates negative
drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and
abduction; and external hip rotation with knee flexion. Based on the above scenario, the
clinician should suspect which of the following?
A left meniscal tear.
Osgood-Schlatter disease.
A left anterior cruciate ligament (ACL) tear.
Lateral meniscus.
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SCFE is a displacement of the femoral head relative to the femoral neck that occurs
through the physis (growth plate) of the femur. The vast majority of clients with this
condition are obese, as the added weight increases shear stress across the physis. The
mean age at diagnosis is 12 years for females and 13.5 years for males. Surgery is
often required via in situ pin fixation (single screw) to stabilize the growth plate to
prevent further slippage and avoid complications. [Show Less]