Summary and References

Thanks, we hope you enjoyed the case. A bit challenging in places, eh?

Main Points:

1. Diagnostic imaging is useful but expensive - be selective in choosing your tests.

2. Red flag symptoms change your perspective. Time to get active in his management. 

3. A good exam for back pain can be done in 3 minutes if you are efficient.

4. Information systems make information sharing amongst health care providers more efficient.

References:

1. TOP guidelines Low Back Pain

http://www.topalbertadoctors.org/

2. Institute for Clinical Systems Improvement-Health Care Guidelines Adult Acute and Subacute Low Back Pain. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_musculoskeletal_guidelines/low_back_pain/

3. European guidelines for the management of chronic nonspecific low back pain. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G

Eur Spine J. 2006 Mar;15 Suppl 2:S192-300.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454542/

4. Clinical Guidelines-Diagnosis and treatment of Low Back Pain: a joint clinical Practice Guideline from the American College of Physicians and the American Pain Society.

Chou et al.

http://annals.org/article.aspx?articleid=736814

5. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain.

van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B.

Cochrane Database Syst Rev. 2010 Feb 17;(2).

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007431.pub2/abstract;jsessionid=63ADE128D02783CC6660D8040DF3B8A2.d02t02

6. Reliability of the Lumbar Flexion, Lumbar Extension, and Passive Straight Leg Raise Test in Normal Populations Embedded Within a Complete Physical Examination

Hunt, David G. MD, FRCP(C)*; Zuberbier, Oonagh A. BGS, BA*; Kozlowski, Allan J. BSc (PT)*; Robinson, James MD, PhD†; Berkowitz, Jonathan PhD‡; Schultz, Izabela Z. PhD*§; Milner, Ruth A. MSc||; Crook, Joan M. RN, PhD; Turk, Dennis C. PhD#

Spine: December 15, 2001 - Volume 26 - Issue 24 :pp 2714-2718

http://journals.lww.com/spinejournal/Abstract/2001/12150/Reliability_of_the_Lumbar_Flexion,_Lumbar.18.aspx

7. The Sensitivity of the Seated Straight-Leg Raise Test Compared With the Supine Straight-Leg Raise Test in Patients Presenting With Magnetic Resonance Imaging Evidence of Lumbar Nerve Root Compression

Alon Rabin, Peter C. Gerszten, Pat Karausky, Clareann H. Bunker, Douglas M. Potter, William C. Welch

Archives of Physical Medicine and Rehabilitation Volume 88, Issue 7 , Pages 840-843, July 2007

http://www.archives-pmr.org/article/S0003-9993(07)00304-8/fulltext

8. Imaging the back pain patient.

Maus T.

Phys Med Rehabil Clin N Am. 2010 Nov;21(4):725-66.

http://www.ncbi.nlm.nih.gov/pubmed?term=Phys Med Rehabil Clin N Am. 2010 Nov;21(4):725-66.

9. Usefulness of neurological examination for diagnosis of the affected level in patients with cervical compressive myelopathy: prospective comparative study with radiological evaluation.

Matsumoto M, Ishikawa M, Ishii K, Nishizawa T, Maruiwa H, Nakamura M, Chiba K, Toyama Y.

J Neurosurg Spine. 2005 May;2(5):535-9.

http://www.ncbi.nlm.nih.gov/pubmed?term=J Neurosurg Spine. 2005 May;2(5):535-9.

10. Acute lumbar disk pain: navigating evaluation and treatment choices.

Gregory DS, Seto CK, Wortley GC, Shugart CM.

Am Fam Physician. 2008 Oct 1;78(7):835-42.

http://www.aafp.org/afp/2008/1001/p835.html

11. Quantitative sensory testing and mapping: a review of nonautomated quantitative methods for examination of the patient with neuropathic pain.

Walk D, Sehgal N, Moeller-Bertram T, Edwards RR, Wasan A, Wallace M, Irving G, Argoff C, Backonja MM.

Clin J Pain. 2009 Sep;25(7):632-40. doi: 10.1097/AJP.0b013e3181a68c64. Review.

http://www.ncbi.nlm.nih.gov/pubmed?term=Clin J Pain. 2009 Sep;25(7):632-40. doi: 10.1097/AJP.0b013e3181a68c64. Review.

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