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OPD LOWER BACK ACHE CASES

 WEEK 2 OPD CASES(MAY 1- MAY 7)


1.Op no. 20230502323

A 26Y/F

C/o Lower Back pain since 4 days, associated with B/L lower limb pain

C/ o frontal Headache since 1 day 

No h/O fever, giddiness, nausea, vomiting, burning micturition. 

Advised Admission, patient not willing for admission.



2.Op no- 20230503366

60Y/F

C/O neck pain since 1 month associated with headache and tingling sensation of both hands. 

H/O lower back pain, dragging type, radiating to lower limbs and associated with tingling sensations.

Sent for Orthopaedics referral


3.Op no 20230503413

67/F 

C/O lower back pain radiating along right lower limb associated with h/o tingling sensation since 1 week 

No h/o trauma. N/k/c/o DM, HTN. 

Advised admission for further evaluation but patient not prepared and not willing for admission


4.Op no. 20230502323

A 26Y/F

C/o Lower Back pain since 4 days, associated with B/L lower limb pain

C/ o frontal Headache since 1 day 

No h/O fever, giddiness, nausea, vomiting, burning micturition. 

Advised Admission, patient not willing for admission.


5. Op no. 20210511847

46y/F

C/O Neck pain since 3 months radiating to right side, associated with tingling sensation, lower backache radiating to right side 

Weight gain of 5 kgs since 1 month, increased appetite, hair loss

ADVISED ADMISSION FOR FURTHER EVALUATION.


6. Op no- 20230503366

60Y/F

C/O neck pain since 1 month associated with headache and tingling sensation of both hands. 

H/O lower back pain, dragging type, radiating to lower limbs and associated with tingling sensations.


7. Op no 20230503413

67/F 

C/O lower back pain radiating along right lower limb associated with h/o tingling sensation since 1 week 

No h/o trauma. N/k/c/o DM, HTN.


8. Op no. 20230504136

30/F

C/O fever for 6 months

C/O low back ache non radiating for 10 days


9. Op no. 20210213183

66/M

C/O pain in epigastric region for 1 day

C/O of lower back ache for 1 day

K/c/o bronchial asthma and on homeopathic medication.


10. Op no 20230500479 

57/F 

C/o back pain since 3 years 

C/o leg pains since 3yrs 

K/c/o CKD since 1 yr 3 HD done 

K/c/o HTN since 5yrs on T.CLINIDIPINE 10MG 

N/k/c/o DM, epilepsy,Tb


11. Op no:20230510267

40/F

C/o lower back pain since 10days(dragging type )

C/o tingling sensation of B/L lower limbs since 1 month

K/c/o type 2 DM since 6 months (on regular medication Glimi -m1)

Not a k/c/o HTN,TB ,asthma ,CVA.


12. Op no: 20230510307

38/F

C/o headache (frontal region)since 1 year 

Associated with neck pain and radiating to both upper limbs 

C/o facial puffiness since yesterday night 

C/o low backache since 1 year 

And Tingling and numbness of both lower limbs 

Not a k/c/o HTN ,DM ,thyroid ,epilepsy ,CAD.


13. Op no:20230510341

33/M

C/o pain in lower back region since 1 week

C/o burning micturition since 1 week associated with increased frequency of micturition 

No h/o Fever 

Not a k/c/o HTN ,DM. ,TB ,epilepsy, CVA.



WEEK 3 OPD CASES(MAY 8- MAY14)


1. Op no:20230510341

33/M

C/o pain in lower back region since 1 week

C/o burning micturition since 1 week associated with increased frequency of micturition 

No h/o Fever 

Not a k/c/o Htn,DM,TB ,epilepsy,cva 

Patient is advised for admission but not willing.


2. Op no:20210318049

C/o tightness of abdomen ,bloating + aggravated on intake of spicy food 

C/o low backache since 2 years , aggravated on bending down ,relieved on rest 

C/o nocturia since 2 months ,burning micturition+

No polyphagia and polydypsia

N/k/c/o HTN;DM;CVA;CAD,TB,Asthma

Patient is a known case of hypothyroidism since 5 yrs on medication since 1 yr 50 mcg ----->75 mcg po/od

K/c/o  Renal calculi since 6 months ,used medications 2.


On examination:BP:130/90 mm hg 

PR:84BPM

P/A:SOFT,NON TENDER 

CVS:S1,S2 HEARD NO MURMURS 

CNS:NFND.

RS:BAE PRESENT.NVBS HEARD.

PATIENT ADVISED FOR ADMISSION 

BUT NOT WILLING



3. Op no. 20210522567

C/o b/l back pain from 1 month sharp type, intermittent in nature associated with aggrevated on physical exertion, deep seated pain 

C/o hematuria 2 episodes in last 1 month

No h/o pedal edema facial puffiness

Pt advised for admission but not willing



4. Op no 20230512604

C/o headache with neck pain associated with left upper limb pain and tingling sensation since 15 days

Low backache since 1 week non radiating

No C/o photophobia phonophobia vomiting lacrimation

N/k/c/o DM HTN TB asthma.



5. op no:20230518608

33/F

C/o low back ache since 20 days

Left sided radiating to left lower limb

Tingling sensation present 

No C/o numbness,weakness

N/k/c/o HTN,DM,Asthma,TB,epilepsy,thyroid disorders

No similar complaints in the past

No pain/tingling of right lower limb

O/E:

Pt is c/c/c

RS:BAE+

NVBS

CVS:s1,s2+

No murmurs

CNS:NFND

Patient advised for admission but not willing



6. op no:20230519836

55/M who is a daily labour by occupation wakes up every morning at 7am,then at 8 am he has breakfast ,then he goes to daily labour work but stopped  his  daily labour work due to sudden onset weakness left upper limb and left lowerlimb 3years back ( CVA) and was on ecospirin av but he stopped medication after using for 15days . He was not using medication due to affordability issues . 

H/o low backache radiating to b/l lower limbs associated with tingling sensation of distal extermities 1yr 

And he was given nsaids with pregabalin.

He noticed development of pedal edema after using pain killers he stopped taking them

 Now ,came  with Complaints ofdragging type of pain lf lowerlimb so he was unable to do his daily labourer job

K/c/o HTN  since 3years but not using any medication

0/E

Patient c/c/c

CVS: s1s2 heard 

RS: BAE + NVBS +

P/A soft ,Non tender

CNS: antalgic gait

 Advised admission but not willing for admission



7. O.P: 20230519436

50/F

Daily Labourer by occupation came with C/O: Lower back ache and tingling sensation in  both the feet since 2 months,She stopped going to work since then and complains of pain even while rest

K/c/o: HTN since 1 yr. and on regular medication. 

O/E: 

Pt is C/c/c 

No tenderness in neck 

No tenderness in spine 

No restriction of movements 

CVS : S1   S2 + No murmurs 

RS : BAE + NVBS + 

P /A: Soft NonTender 

CNS : NFND

Diag : ? Lumbar spondylosis.


8. Op no 20210411219

32 M

A supermarket worker came with c/o  pain in lower rgt sacral dimples radiating to rt lumbar region since 15days

No h/o increased frequency of urine, burning micturation,fever

Pain is increased on bending forward and relieved on its own without taking medication

Routine 

Regular travel on bike from home to shop

Mild pain experience on traveling after bending forward which is dragging type of pain experience atleast 4times per day

Not a k/c/o DM,htn,tb,cva,cad, epilepsy, asthma

Diagnosis -?lower backache

Pt was advised for admission but not willing



9. Op no 20230521293

60F

Pt was homemaker do farming activities during free time but stopped working from past 20yrs due to increase in age from that she wakes around7am and do normal small household activities and takes rest but from past 2month she has difficultly in standing, walking,passing urine

Pt came with c/o pain in low back, dragging type of pain radiating to left lower limb upto knee since 2-3 months


Able squat and stand byherselfand pain on standing 

K/c/o htn since 10yrs on medication (atenolol 50mg+amlodipine 6mg) po od

Pt is c/c/c

Musculoskeletal system examination 

On right side

Straight leg test  -60degree positive

Pain on abduction,adduction, external rotation of hip joint

Sacroiliac joint tenderness

Cvs s1s2 heard no murmur

Cns nfnd

Rs BAE present

P/a soft non tender

Diagnosis -?sciatica 

Patient was adviced xray of spine  and adviced for  admission but not willing



10. Op no 20210114449

32F 

Teacher by occupation

Her daily routine

Wakes up at 530am in the morning and completes her household chores by 7am and have her breakfast by 8 am and goes to school at 1230pm she will have her lunch and continues the work comes back home by 5pm and do the house work and eats dinner by 8pm and goes back to sleep by 10pm 

came with complaints of low backache since 1 month non radiating not associated with tingling sensation of lower limb 

No h/o trauma

H/o increase in pain on prolonged sitting or bending forwards decreased on lying down on bed

No h/o renal calculi

O/E

SLRT -Ve

Paraspinal muscle tenderness

Cvs S1 S2+

RS BAE+

P/A soft and non tender

Provisional diagnosis:Myofacial pain due to overuse



WEEK 4 OPD CASES(MAY 15 -MAY 21)


1. Op no.20230523500 


C/o of neck pain since 4 days

Radiating towards right upper limb associated with tingling sensation,no history of weakness ,no history of trauma.

History of headache on and off since 10 years.

No history of unilateral headache.

Headache is associated with nausea and vomitings. 

Photophobia present and phonophobia present. 

Cheif complaints of lowerbackache radiating to right lower limb.associated with tingling since 2 days.

No history of tingling or numbness over the trunk or face.

General examination:Patient is conscious coherent and cooperative. 

Moderately built and moderately nourished. 

No palloricterus,cyanosis,clubbing,lymphadenopathy,edema.

Vitals:

Bp:110/80 mmhg

Pr:80 bpm

Rr:18cpm

Temp :afebrile.

Systemic examination:

Cvs:s1,s2 heard No murmurs 

Rs:BAE+and no murmurs. 

PA:SOFT AND non tender 

CNS:                

Power:ul : 5/5.     

          Ll:   5/5.      

TONE:NORMAL

Reflexes:B:1+

             T:1+

             S:1+

              K:1+

              A:-- 


Treatment ×1week 


Tab: Ultracet BD

1/2--0---1/2 


Tab:multivitamin OD

0--1--0.



2.Op no 20230525827

44/M 


C/O  low Back ache since 1 Year

 Pricking type of pain in both feet since 6 months 

B/L knee Pains Since 5 months 


H/O pain in left loin radiating to the front of abdomen for which he visited hospital and was found to have renal calculus and has started medication for the same since then but pain did not subside. 


Daily Routine - wakes up at 6 am & he climbs tree for toddy.


N/K/C/O HTN, DM, TB, Asthma,CAD,CVA, Epilepsy, Thyroid Disease 




Vitals:

Bp:80/60 mmhg

Pr:86bpm

RR- 18 cpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R/S- BAE,NVBS heard

L/E- no spine deformity/ tenderness 

Crepitus + in both knee joints


3.Op no:20230527237

50/F c/o neck pain since 2 yrs

C/o difficulty in walking with lBA ,non radiating since 2 years ,increased on bending, unable to extend the limb completely(more since 6 months)


C/o neck pain right more than left,radiating to shoulder with mild restriction of movements to right 

Used NSAIDS on and off

O/E:-

SLR-negative

Right Hip:- restriction with pain of felxion,extension,adduction,abduction 

Tenderness along joint line

Left Hip:- mild tenderness with restriction 

Reflexes(2+)

Neck: paraspinal tenderness with restriction of right sd neck

Gait:- Antalgic with right waddle



N/k/o HTN, DM,epilepsy,asthma thyroid,CVA


Vitals:

Bp:100/80mmhg

Pr:82bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard



4. Op:20230526412

20/F c/o lower backache,dragging type radiating to the cervical spine region with headache in occipital region since 1 week

No fever,vomoting.

C/o giddiness since 7 to 8 yrs only when temperature present

H/o angioplasty done 18 yrs back not on any medication


N/k/o HTN, DM,epilepsy,asthma thyroid,TB.


Vitals:

Bp:90/60mmhg

Pr:80bpm

P/a: soft,non tender

Cvs:S1S2 heard ,no murmers

CNS: NFND

R.s:BAE,NVBS heard



5. Op no. 20230426632

46/M

C/O tingling, numbness in right hand little finger since 10 days

C/O low backache since 10 days (stiffness present) ,no h/o trauma, aggravating factors-on bending forward pain increases, relieving factors-pain decreases on walking for some distance

K/C/O HTN since 3 months on medication (metoprolol 25 mg and clinidipine 10mg) 

Vitals:-

BP:-130/80 mm hg

PR:-86bpm



6. OP NO:20230529824


C/o 

-lower backache since 2 months which is increased on bending downwards

-neck pain since 2 months and no restriction of movements


Vitals:

BP:120/80mmHG

Weight:109kg


CNS: NFND

CVS: S1 and S2 heard, no murmurs

RS: BAE,NVBS heard

P/A: soft and non tender


Not a known case of DM,HTN,asthma,epilepsy,TB and thyroid abnormalities 


Advice:

-Diet modification 

-Avoid junk food

-Regular exercise



7. Op no:20230531635 

76/M 

C/o lower back ache since 2 years 

Both knee pain since 2 yrs 

Neckpain since 2 yrs

Headache since 2 yrs 

K/c/o HTN since 2 yrs and on regular medication 

N/k/c/o DM,TB, epilepsy and asthma 

O/E 

Tenderness present in cervical and lumbar spine 

Extension of neck is limited

Crepitus present in knee joint  

Daily routine -

Wakes at 6am eats breakfast at 8am and lunch at 1pm(rice and curry) and dinner at 8pm(Roti). 

Used to do farming before 2 yrs but stopped working due to backpain.

CVS- S1 S2 heard no murmurs

RS-BAE+ NVBS 

P/A- soft non tender 

CNS-NFND






WEEK 5 OPD CASES(MAY 22- MAY 28)


1. OP NO: 20230535214


60F

C/o low backache since 5 to days radiating to left lower limb

Neck pain since 1 week with head ache associated with giddiness / tingling sensation of upperlimbs bilateral 



k/c/o HTN since  3 years ,

n/k/c/o thyroid,epilepsy,cad,cva

H/o trauma to head due to slip and fall 

IC bleed  left hemiplegia since 2years

H/o lumbar and cervical spondylosis 1 year back


O/E:  

Cvs- s1s2 heard

RS - BAE + , NVBS heard

P/A - soft,nt

CNS HMF intact 

Pupils b/l nsrl

Cranial nerves intact

Motor system normal 

Tone  normal 

Power  ul.       Ll

    Rt    4/5    4/5

    Lt    3/5    2/5

Reflexes 

        B   T    S    K   A  Plantar


Rt.   -      -     -     -     -     flxn

Lt   +3  +3 +3  +3  +2.  Extsn


Advice 

Physiotherapy of left upper and lower limb



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