Persistent pain in the lower back
Introduction
Introduction The persistent pain in the lower back is mostly caused by the injury of the lower back, which is common in lumbar muscle strain, lumbar back muscle fasciitis, and lumbar disc herniation.
Cause
Cause
The cause of persistent pain in the lower back:
Seen in lumbar muscle strain, lumbar myofascial fasciitis, lumbar disc herniation, can also be seen in the symptoms of worsening of cardia cancer, in addition to dysphagia in advanced cases, there may be persistent pain in the upper abdomen and lower back, indicating that cancer has been involved Retroperitoneal tissue such as the pancreas is a contraindication for surgery.
Examine
an examination
Related inspection
CT examination of bone and joint soft tissue
First, the examination of lumbar muscle strain:
1. X-ray examination: no abnormalities, a few and may have bone hyperplasia or spinal deformity.
2. Elderly patients with osteoporosis, ECT examination, bone density examination can be selected.
Lumbar muscle strain, also known as "functional low back pain" or "back muscle fasciitis", mainly refers to chronic injury of soft tissue such as lumbosacral muscles and fascia. Lumbar muscle strain is the largest proportion of chronic low back pain. Mostly caused by acute lumbar sprain injury, mistreatment, repeated injuries; or due to the maintenance of an unbalanced position in the long-term labor, such as long-term work in bending; or due to habitual posture and other problems. Congenital malformations of the lumbosacral vertebrae cause inconsistent movements on both sides of the lumbosacral region, which may lead to fatigue of the lumbosacral soft tissue and cause low back pain. The patient has a history of long-term low back pain and repeated episodes. One side or both sides of the lumbosacral area are sore and uncomfortable, when it is light and heavy, it is not lingering. Soreness is exacerbated after exertion, relieved after rest, and is associated with weather changes. In the acute exacerbation of lumbar muscle strain, various symptoms are significantly aggravated and waist activity is limited. Acute lumbar sprains have not been properly treated or treated incompletely; long-term poor posture caused by lumbar soft tissue strain, making the lumbar muscles easy to fatigue and prone to pain, said chronic lumbar muscle strain lumbar soft tissue strain.
Second, the diagnosis of low back muscle fasciitis:
When the body is stimulated by external factors such as cold, fatigue, trauma or improper sleeping position, it can induce an acute attack of lumbar muscle fasciitis. The acute or chronic injury or strain of the muscles, ligaments and joint capsules of the lower back is The basic cause of the disease. Chronic lower back muscle pain, soreness and weakness can be repeated due to repeated stress or cold and other adverse stimuli due to repeated treatment in the acute phase.
Third, the diagnosis of lumbar disc herniation:
(1) Low back pain and radiation pain in one lower limb are the main symptoms of the disease. Low back pain often occurs before leg pain, but it can also occur at the same time; most have a history of trauma, but there is no clear incentive. Pain has the following characteristics:
1. Radiation pain is transmitted along the sciatic nerve to the outside of the calf, the back of the foot or the toes. If the waist 3-4 gap protrudes, the nerve root of the waist 4 is compressed, causing radiation pain to the front of the thigh.
2. All actions that increase the pressure of the cerebrospinal fluid, such as coughing, sneezing and defecation, can aggravate low back pain and radiation pain.
3. Pain is aggravated during activities and relieved after rest. Bed position: Most patients use the lateral position and flexion of the affected limb; individual severe cases are painful in various positions, and can only bend the knee and knees in the bed to relieve symptoms. Patients with lumbar spinal stenosis often have intermittent claudication.
(B) scoliosis deformity: the main bend in the lower back, more pronounced in the flexion. The direction of the lateral curve depends on the relationship between the protruding nucleus and the nerve root: if the protrusion is located in front of the nerve root, the trunk is generally bent to the affected side. Left: The nucleus pulposus is located in front of the nerve root, and the spine is bent to the affected side. If the curve is curved to the healthy side, the pain is aggravated. Right: the nucleus pulposus is located in front of the nerve root, and the spine is bent to the healthy side, such as to the affected side. The pain is getting worse.
(3) The spinal cord is restricted by the nucleus pulposus, and the nerve root is compressed, so that the psoas muscle is protectively tight and can occur on one side or both sides. Due to the tension of the lumbar muscles, the physiological lordosis of the lumbar spine disappears. Spinal flexion and extension activities are limited, and there may be radiation pain to one side of the lower limb when flexion or extension. Side bending is often limited to one side, which can be differentiated from lumbar tuberculosis or tumors.
(D) lumbar tenderness with radiation pain in the disc herniation site of the affected side of the spinous process has a limited tender point, accompanied by radiation pain to the calf or foot, this point is important for diagnosis.
(5) Straight leg raising test is positive Because of the difference in personal physique, there is no uniform degree standard for the positive test of this test, and attention should be paid to the comparison between the two sides. The affected leg is restricted and the radiation pain to the calf or foot is positive. Sometimes raising the healthy limb and causing numbness in the affected leg is caused by the pulling of the affected nerve. This point is of great value for diagnosis.
(6) When the nervous system examines the waist 3-4 protrusion (the waist 4 nerve root is compressed), the knee reflex may be reduced or disappeared, and the inner side of the calf may be reduced. When the waist 4-5 protrudes (the waist 5 nerve root is compressed), the anterior and posterior aspect of the calf feels diminished, and the extension and the second toe muscle strength often decrease. When the waist 51 protrudes (1 nerve root is compressed), the lower leg and the lateral side of the lower leg feel diminished, the third, fourth, and fifth toe muscle strength decreases, and the Achilles tendon reflex declines or disappears. If the symptoms of nerve compression are severe, the affected limb may have muscle atrophy.
If the protrusion is large, or the central type is prominent, or the nucleus pulposus fragment of the annulus fibrosus protrudes to the spinal canal, a wide range of symptoms of nerve root or cauda equina may occur, and the numb area of the affected side is often extensive, including nucleus pulposus Below the plane, the affected side of the buttocks, the lateral side of the femur, the lower leg and the foot. Central type of prominence often has nerve damage symptoms in both lower limbs, but one side is heavier; should pay attention to check the feeling of saddle area, often one side is reduced, sometimes both sides are reduced, often have urinary loss of control, wet pants bedwetting, constipation, sexual function Obstacles, even part of the lower limbs or most of the lower limbs.
Diagnosis
Differential diagnosis
Identification of persistent and confusing symptoms of the back of the lower back:
Lumbar muscle strain: long-term sitting and bending workers are prone to occur. It is characterized by persistent low back pain, soreness, rest in the flat and moderately slow activity. But it is not easy to completely relieve.
Lumbar back muscle fasciitis: manifested as persistent low back pain, soreness, occurrence or aggravation during rainy days and climate change, no relief after supine rest, can be alleviated after appropriate activities.
Lumbar disc herniation: long-term sitting and bending workers are prone to occur, and some have a history of "waist sprains." It is characterized by persistent low back pain and soreness. In the acute phase, there is severe pain in the lower back and limited waist activity. The rest, traction and massage can be relieved. Compression nerve can be manifested as a soreness, pain, numbness in one lower limb, and aggravation after walking. It can also be manifested as lumbosacral, perineal acid soreness and soreness and weakness of both lower limbs. More emphasis on aggravation - aggravation of the process of circulatory disease, lumbar CT or lumbar magnetic resonance examination has a corresponding performance.
