tailieunhanh - PRINCIPLES OF NEUROLOGY - PART 3

Dây chằng chậu (đau chậu bong gân, thường xuyên đấu thầu với thắt lưng thứ năm vào đĩa xương cùng đầu tiên). (9) Sacrococcygeal ngã ba (đau sacrococcygeal chấn thương, tức là, bong gân hoặc gãy xương). (10) khu vực notch sacrosciatic (đau thứ tư thứ năm vỡ đĩa đệm thắt lưng và bong gân chậu) | 102 PART II CARDINAL MANIFESTATIONS OF NEUROLOGIC DISEASE FIG. 11-1 1 Costovertebral angle renal pain . 2 Spinous process and interspinous ligament. 3 Region of L5-S1 articular facet facet joint pain . 4 Dorsum of sacrum. 5 Region of iliac crest. 6 Iliolumbar angle. 7 Spinous processes of fifth lumbar to first sacral vertebrae tenderness metastasis faulty posture or occasionally spina bifida occulta . 8 Region between posterior superior and posterior inferior spines. Sacroiliac ligaments tenderness sacroiliac sprain often tender with fifth lumbar to first sacral disc . 9 Sacrococcygeal junction tenderness sacrococcygeal injury . sprain or fracture . 10 Region of sacrosciatic notch tenderness fourth to fifth lumbar disc rupture and sacroiliac sprain . 11 Sciatic nerve trunk-sciatic notch tenderness ruptured lumbar disc or sciatic nerve lesion . serum immunoelectrophoresis Ca P acid and alkaline phosphatase prostate-specific antigen if metastatic carcinoma of the prostate is a diagnostic possibility and rheumatoid factor. Tuberculin skin test and in endemic areas Brucella antibody test should be carried out if there is a suspicion of chronic infectious disease. Plain films of the spine bone scans CT scans with or without enhancement or myelography CHAPTER 11 PAIN IN THE BACK NECK AND EXTREMITIES 103 MRI and in cases of discogenic disease electromyography nerve conduction studies and sensory evoked potentials are important ancillary procedures. Myelography is customarily reserved for patients in whom there is a strong suspicion of ruptured disc tumor or spinal stenosis and a likelihood of surgery. Common Conditions Causing Low-Back Pain The age of the patient makes certain diagnostic possibilities more or less likely. Sprains postural abnormalities scoliosis kyphosis congenital malformations . spondylolisthesis and spondylolysis and osteochondritis Scheuermann disease are the most frequent causes of chronic back pain in childhood and adolescence. Lumbosacral .