I guess though you can get this STD with a condom. Your Friends’ Emails: So, the main guidelines about shingles are very general and should not discount anyone who suffers from this if they fall outside the norm for the condition i. By Mayo Clinic Staff. 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Lumbar Spinal Musculature Sacroiliac Joint Quadratus Lumborum MuscleDifferential Diagnosis Mechanical Low Back or Leg Pain The Leading Cause Of Low Back Pain (97%) Types: Lumbar strain (70%) Degenerative processes of disks and facets (10%) Herniated disk (4%) Spinal stenosis (3%) Osteoporotic compression fracture (4%) Spondylolisthesis (2%) Traumatic Fracture ( Congenital Disease ( Visceral Disease (2% of All Low Back Pain) Types: Disease of pelvic organs: prostatitis, endometriosis, chronic PID Renal Disease: nephrolithiasis, pyelonephritis, perinephric abscess Aortic aneurysm GI disease: pancreatitis, cholecystitis, penetrating ulcer Nonmechanical Spinal Conditions (1% of All Low Back Pain) Types: Neoplasia: multiple myeloma, mets, lymphoma, leukemia, spinal cord tumors, retroperitoneal tumors, primary vertebral tumors (0.7%) Infection: osteomyelitis, septic diskitis, paraspinous abscess, shingles (0.01%) Inflammatory arthritis: Ankylosing spondylitis, psoriatic spondylitis, Reiter’s syndrome, IBD(0.3%) Radiculopathy: Herniated Nucleus Pulposis (HNP) L4-S1 in 95% of cases of radiculopathy L2-4 in 2-5% 75% of those with cauda equina syndrome have saddle anesthesia L5 radiculopathy: pain/dysesthesia in posterior thigh and anterolateral leg; foot drop with weakness on dorsiflexion S1 radiculopathy: pain/dysesthesia in posterior thigh and leg, posterior lateral foot; weak plantar flexion; decreased Achilles reflex Compression Fracture: Acute, severe onset of focal pain Elderly, prednisone therapy and SLE predispose Pain will resolve spontaneously in 3-6 months Inflammatory Back Disease: morning stiffness, symptoms better with activity, worse with rest, young person ( Ankylosing Spondylitis Reiter’s Syndrome Arthritis of Inflammatory Bowel Disease Psoriatic Arthritis Spinal Stenosis: better with flexion of back, bilateral neurologic deficits, wide-base gait Degenerative (seen in elderly; most common) Congenital Pseudoclaudication/Neurogenic claudication Infection Mycobacterium Tuberculosis (Pott’s Disease) Paravertebral Abscess Intervertebral discitis or osteomyelitis Herpes Zoster Pyelonephritis Endocarditis Primary cancer: Multiple myeloma Lymphoma Metastatic cancer: Pancreatic Prostate Breast Renal Cell Thyroid Lung Colon Red Flags Weight loss, fever History of cancer, exposure to TB, IV drug abuse Age > 50 Adenopathy Neurological symptoms uni/bilateral urinary retention saddle anesthesia Writhing in pain (visceral/vascular) Unrelenting pain at rest (infection/ malignancy) Physical Exam Inspection Posture shoulders and pelvis level normal lordotic/kyphotic curve present Skin abnormalities Gait Palpation Range of motion Flexion (> 60 degrees*) Schober’s test floor-to-finger measurement Extension (> 25 degrees*) Lateral Bending (> 25 degrees*) Rotation *values for which no disability would be assigned Neurologic examination Motor Sensory DTRs Pathologic reflexes Cord levels (Motor, sensation and reflexes)Radiographs Indications in acute low back pain: -Age > 50 -History of serious trauma -History of cancer -Pain at rest -Unexplained weight loss -Drug/alcohol abuse -Previous treatment with steroids -Temperature > 38° C or 100.4° F -Suspicion for inflammatory cause -Neuromotor deficit -Systemic symptomsBiomedical Treatment Acute: -Bed rest: patients functional in 6.6 days compared to 11.8 days for those kept ambulatory; more beneficial in radiculopathy 2 days of bed rest are as effective as 7 days and results in 45% less time away from work -Analgesics -Muscle relaxants: controversial -Aerobic exercise -Weight loss -Stop smoking Chronic -Back exercises -Williams/flexion exercises: better tolerated -Extension exercises: may be more efficacious -Physical Therapy -Ultrasound -Diathermy -TENS -Exercise instruction -Traction -Bracing: controversial; not clearly efficacious; may weaken back/abdominal musculature -Facet injection: probably not effective -Epidural Steroid Injection for radiculopathy controversial -66% with sx -33% with sx > 12 months show improvement -Narcotics in chronic LBP are best avoided -Antidepressants in low doses may be beneficial Surgery -USA rates > twice other developed countries -Important neurologic deficits (i.e., foot drop) best treated surgically -Long-term functional outcome unaffected if surgery delayed up to 12 weeks Indications: -Progressive or severe neurologic deficit -Persistent neuromotor deficit despite 4-6 weeks conservative therapy -Persistent radiculopathy, sensory deficit or reflex loss after 4-6 weeks conservative therapy with +SLR, consistent clinical findings and favorable psychosocial circumstances (no depression, substance abuse or somatization disorder)Biomedical Outcome Acute: Resolution of pain (without sciatica) in 6 weeks with nonspecific treatment in 75-90% 60% will have a recurrence within one year 50% with sciatica recover in 6 weeksTCM Disease Classification Yao Tong = “lumbar or low back pain” -According to TCM, the low back is the domain of the Kidneys.