Advertisement

Advertisement

Articles

Acne Vulgaris: 2023 Update

Teaser: 

Amir Gohari1 Joseph M. Lam, MD, FRCPC,2

1 University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Acne vulgaris is a chronic pilosebaceous inflammatory disorder that affects almost 85% of those aged 12 to 24 years. Its pathophysiology is an interplay between androgenic activity, follicular epidermal hyperproliferation, retention hyperkeratosis, and Cutibacterium acnes infection. Strong evidence exists for high glycemic index diet as a trigger. Diagnosis is clinical and management is based on lesion types, with options including retinoids, benzoyl peroxide, antibiotics, oral contraceptives, and spironolactone.
Key Words: acne vulgaris, inflammatory disorder, comedones, Cutibacterium acnes.
Acne vulgaris is the most common skin condition observed in adolescent and pre-adolescent patients and has a significant psychological burden.
The plugged follicles of acne allow for Cutibacterium acnes overgrowth which triggers the release of heat shock proteins, porphyrin, proteases, and squalene peroxides, leading to inflammation.
Topical retinoids are used for open and closed comedones, while topical antibiotics and benzoyl peroxide are used for inflammatory lesions. Oral antibiotics are added for moderate to severe inflammatory acne. Hormonal therapy and isotretinoin are used to target the excess sebum production.
Acne may reflect an underlying disease. Patients that present before 7 years of age may have an underlying endocrinopathy. For women with acne, the possibility of polycystic ovary syndrome (PCOS) should be addressed.
Acne lesions can be non-inflammatory, in the form of open or closed comedones, and/or inflammatory, in the form of papules, pustules, and nodules. Treatment should be targeted to the type of acne the patient presents with.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Dermatology, acne vulgaris, inflammatory disorder, comedones, Cutibacterium acnes
Disclaimer: 
Disclaimer at the end of each page

Degenerative Cervical Myelopathy: Navigating Management in the Primary Care Setting

Teaser: 

Karlo M. Pedro, MD,1 James Milligan, MD,2 Michael G. Fehlings, MD, PhD,3

1 Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
2 McMaster University, Department of Family Medicine, Hamilton, ON, Canada.
3Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.

CLINICAL TOOLS

Abstract: Degenerative cervical myelopathy (DCM) is a progressive and acquired spinal disorder that represents a potentially reversible cause of spinal cord impairment among adults. It remains underdiagnosed due to a low level of awareness amongst the public and healthcare professionals. Diagnosis is anchored on high clinical suspicion after a thorough history and physical examination and confirmed using magnetic resonance (MR) imaging of the cervical spine. Improving early diagnosis and ensuring timely surgical intervention are crucial in preventing long-term disability and optimizing long-term outcomes for DCM patients.
Key Words:degenerative cervical myelopathy, myelopathy, non-traumatic spinal cord injury, primary care.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
DCM is the most common cause of non-traumatic spinal cord dysfunction among adults worldwide
DCM is a potentially reversible disease with profound neurologic implications if left untreated
A thorough history and physical examination, supplemented with MR imaging of the cervical spine, are key elements to avoid misdiagnosis and delays in management
The hallmark signs of DCM are deterioration of hand motor function (eg. decreased coordination/clumsiness) as well as gait instability
MRI is the imaging of choice to confirm a diagnosis of DCM
Surgery is the only proven therapy that can halt the progression of DCM
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, degenerative cervical myelopathy, myelopathy, non-traumatic spinal cord injury, primary care

GLA:D® Back

Teaser: 

Brandyn Powelske, PhD Candidate, 1 Greg Kawchuk, 2 Ted Findlay,3

1 Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta.
2 Professor, Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta.
3Medical Staff, Calgary Chronic Pain Centre at Alberta Health Services, Calgary. Alberta.

CLINICAL TOOLS

Abstract: While low back pain is one of the most common clinical conditions seen in a family physician's office, there remains a lack of low or no cost initial treatment options that are concordant with recognized best practice guidelines. As a result, many patients are offered investigations and treatments that have limited value and/or significant risks but are readily available through publicly funded provincial health care systems. GLA:D® Back builds upon the successful GLA:D model (initially developed for hip and knee osteoarthritis patients) by using the same established methodology to deliver a patient education and targeted rehabilitation program for low back pain.
Key Words: low back pain; best practice; guidelines; education; rehabilitation.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Low Back Pain remains one of the most seen conditions in a family medical practice, and chronic low back pain the leading cause of ongoing disability
2. There are significant patient financial and access barriers to treatment modalities most consistently recommended in practice guidelines: education and activity/rehabilitation-based therapies.
3. GLA:D Back presents a validated option that can help close the gap between recommended treatments for low back pain and access through a primary care practice.
4. GLA:D Back is an extension of the well-recognized and widely used GLA:D program for hip and knee osteoarthritis.
In the absence of clinical "Red Flags", avoid ordering unnecessary imaging when the results are not needed for investigating an established clinical diagnosis or to initiate a therapeutic procedure.
When considering pharmacotherapeutic options, remember that the Institute for Safe Medical Practices (Canada Institute for Safe Medication Practices Canada notes that opioids should generally be avoided in the treatment of low back pain, headache and fibromyalgia.
The Covid-19 Pandemic has taught us that many group based education and rehabilitation-based programs can be effectively delivered in a virtual format.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, best practice guidelines, education, rehabilitation

Spine Surgery Considerations in the Aging Population

Teaser: 

Erika Leck, MD, PGY 5,1, Sean D Christie, MD, FRCSC, 2,

1 Department of Surgery (Neurosurgery) Dalhousie University.
2 Vice-Chair and Director of Research Professor, Division of Neurosurgery , Department of Surgery (Neurosurgery), Healthy Populations Institute Flagship Project Co-Lead, Creating Sustainable Health Systems in a Climate Crisis, Dalhousie University.

CLINICAL TOOLS

Abstract: The global population is ageing, and with that there is a concomitant increase in spinal pain and mobility complaints, most related to degenerative changes. It is important to consider how the markers of aging and, specifically, frailty, can overlap with symptoms of spine disease. Although non-operative management should be the initial response, spine surgery in older adults is safe and should be considered as part of a holistic approach for patients with persistent neuropathic pain.
Key Words: Spine Surgery, Elderly, Older Adults, Frailty, Imaging, Spinal Degeneration.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. It is essential to remember that, while degeneration is inevitable, the appearance of symptoms is not and treatment decisions must be based on the clinical presentation, not the images.
2. Our ageing population will lead to an increase in the frequency of spine-related complaints.
3. It is important to consider how the markers of aging and frailty overlap with symptoms of spine disease.
4. The conservative approaches should always be pursued prior to consideration of surgical options.
5. When required, spine surgery in older patients is safe and efficacious, but should involve a healthcare team able to appropriately assess and support the patient and their loved ones.
1. Biological age does not necessarily equate to chronological age.
2. Radiological “abnormalities” become more common with age, but are frequently asymptomatic, order tests that direct care.
3. Combination, non-opioid, pharmacological strategies, with a ‘start low and go slow’ approach are preferred.
4. Tools such as the Clinical Frailty Scale can be helpful in predicting risk and clinical decision making.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, spine, surgery, elderly, older adults, frailty, imaging, spinal degeneration

The Types and Treatments of Spondylolisthesis

Teaser: 

Brett Rocos MB ChB MD FRCS (Tr & Orth),1, Daniel Ochieng MB ChB FRCSEd (Neuro.Surg),2,

1 Consultant Spine Surgeon, Department of Spine Surgery, Barts Health NHS Trust, London, UK.
2Complex Spine Fellow, Department of Spine Surgery, Barts Health NHS Trust, London, UK.

CLINICAL TOOLS

Abstract: Spondylolisthesis is a common finding in the adult patient but seldom requires surgical intervention. Up to 18% of the population show spondylolisthesis on spinal imaging with the vast majority requiring little or no treatment. This review explores the aetiology of spondylolisthesis, alongside key findings in the history and examination that should prompt referral, as well as presenting the evidence supporting surgical treatment. Spondylolisthesis affects patients at nearly every stage of life and understanding why and how to manage this common problem will aid in counselling patients and making the right referrals.
Key Words: Spondylolisthesis, spondylosis, back pain, radicular pain, neurogenic claudication, spinal stenosis.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
• Spondylolisthesis affects 18% of adults.
• Surgical treatment for spondylolisthesis is rarely required.
• Risk factors depend on the patient's age and include specific athletic activities, trauma and degenerative changes to the posterior elements.
• Examination findings can be normal.
• Surgical options include repair, decompression, and stabilisation of affected segments.
• Spondylolisthesis is a common incidental finding.
• Not every spondylolisthesis needs treatment.
• Uncontrolled pain is a valid reason for referral.
• Analgesia, physiotherapy, and injection therapy manage most cases successfully.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Spondylolisthesis, spondylosis, back pain, neurogenic claudication, spinal stenosis, radicular pain

Management of Lumbar Radiculopathy Secondary to Lumbar Intervertebral Disc Herniation

Teaser: 

Patrick Thornley, MD, MSc, FRCSC,1, Christopher S. Bailey, MD, MSc, FRCSC,2,

1 London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, Ontario, Canada.
2 London Health Science Centre Combined Neurosurgical and Orthopaedic Spine Program, Schulich School of Medicine, Western University, Ontario, Canada.

CLINICAL TOOLS

Abstract: Lumbar intervertebral disc herniations (IVH) carry a high lifetime prevalence and are the most common cause of sciatica. The vast majority of symptomatic lumbar IVH improve with conservative management though adjuncts such as physiotherapy and epidural steroid injections may play a role in short-term symptom relief. For patients with unresponsive lumbar IVH, discectomy reliably improves symptoms more rapidly than continued conservative care, though there is inconsistent evidence that clinical differences between operative and conservative care are no different at one-year after symptom onset.
Key Words: lumbar radiculopathy, intervertebral disc herniation; lumbar intervertebral disc herniation; lumbar disc herniation; sciatica.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. The natural history of lumbar intervertebral disc herniations causing lumbar radiculopathy is favourable with conservative care in the vast majority of patients.
2. Advanced imaging for patients with lumbar radiculopathy is indicated only in the setting of “red flag” neurologic symptoms or a concerning clinical history for infection, neoplastic or traumatic etiology or the absence of symptom improvement after six-weeks of conservative care.
3. Long-term follow-up demonstrates most patients with lumbar intervertebral disc herniation causing lumbar radiculopathy achieve comparable clinical improvement with surgery or conservative management, with surgery leading to earlier symptom resolution.
4. The high-quality evidence for surgery is weak given the high cross over rate but observational studies show a benefit of surgery after failed non-operative care.
1. The diagnosis is made on the patient’s history including leg dominant pain and confirmed by the physical examination.
2. A combination of a detailed motor and sensory neurologic examination, including supine straight leg raise in addition to cross leg straight leg raise, increases the clinical sensitivity and specificity of a diagnostic examination for lumbar radiculopathy.
3. Analgesics should be used to manage function and not just to reduce pain, taking into account response to the specific analgesic on an individual basis including the known side effect profiles.
4. Microdiscectomy surgery for patients with refractory lumbar radiculopathy lasting greater than four months can lead to a significant reduction in leg pain compared to continued conservative management.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, lumbar radiculopathy, intervertebral disc herniation, lumbar intervertebral disc herniation, Lumbar disc herniation, sciatica

Teaser: 

Brett Rocos MB ChB MD FRCS (Tr & Orth),1, Daniel Ochieng MB ChB FRCSEd (Neuro.Surg),2,

1 Consultant Spine Surgeon, Department of Spine Surgery, Barts Health NHS Trust, London, UK.
2Complex Spine Fellow, Department of Spine Surgery, Barts Health NHS Trust, London, UK.

CLINICAL TOOLS

Abstract: Spondylolisthesis is a common finding in the adult patient but seldom requires surgical intervention. Up to 18% of the population show spondylolisthesis on spinal imaging with the vast majority requiring little or no treatment. This review explores the aetiology of spondylolisthesis, alongside key findings in the history and examination that should prompt referral, as well as presenting the evidence supporting surgical treatment. Spondylolisthesis affects patients at nearly every stage of life and understanding why and how to manage this common problem will aid in counselling patients and making the right referrals.
Key Words: Spondylolisthesis, spondylosis, back pain, radicular pain, neurogenic claudication, spinal stenosis.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
• Spondylolisthesis affects 18% of adults.
• Surgical treatment for spondylolisthesis is rarely required.
• Risk factors depend on the patient's age and include specific athletic activities, trauma and degenerative changes to the posterior elements.
• Examination findings can be normal.
• Surgical options include repair, decompression, and stabilisation of affected segments.
• Spondylolisthesis is a common incidental finding.
• Not every spondylolisthesis needs treatment.
• Uncontrolled pain is a valid reason for referral.
• Analgesia, physiotherapy, and injection therapy manage most cases successfully.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Spondylolisthesis, spondylosis, back pain, neurogenic claudication, spinal stenosis, radicular pain

Public–Medicine Dissonance: Why in a World of Evidence-based Medicine?

Teaser: 

Michael Gordon, MD, MSc, FRCPC,

Emeritus Professor of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: The evolution of medicine is quite remarkable and astounding. Modern medicine is successfully treating or providing long-term control of conditions which in the not-so-distant past were lethal or resulted in permanent disability. The strong emphasis on evidence-based medicine in today's medical profession has led to a more organized approach toward evaluating the safety and efficacy of new medical treatments. Despite attempts to meet the complex needs of an ever-aging population, an almost cynical or inherent distrust of physicians in general and their medical claims is being increasingly noted. For many physicians this has led to an uncomfortable sense of professional frustration as doubt is cast on themselves or the medical profession in general when the expectations and goals of patients or their families are not achieved. The causes of this apparent malady of contemporary medicine are myriad and may be explored from various perspectives, depending on the particular issue. To understand better the issues and challenges involved, today's medical practitioner needs to be aware of the complex mix of organizational, professional, ethical, and at times anthropological perspectives contributing to this dissonance between medical professionals and the public. Improving our insight into the forces at work in this dissonance will help medical professionals improve medical services to the public and contribute to the preservation of medicine's admirable historical legacy.
Key Words: Anti-vaccination movement, conspiracy theories, evidence-based medicine, medical quackery, trust in physicians.
Evidence-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps:
• Formulate a clear clinical question from a patient’s problem
• Search the literature for relevant clinical articles
• Evaluate (critically appraise) the evidence for its validity and usefulness
• Implement useful findings in clinical practice.
The growing mistrust undermines the patient-doctor relationship, as well as the public’s perspective of health care professionals and the system in general.
If the medical dissonance is left unresolved, the future of health care will become increasingly onerous for those wishing to enter its professions, ultimately impacting those in need of medical services.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Law and Ethics, anti-vaccination movement, conspiracy theories, evidence-based medicine, medical quackery, trust in physicians

A Practical Guide to Managing Low Back Pain in the Primary Care Setting: Imaging, Diagnostic Interventions and Treatment—Part 2

Teaser: 

Conner Joseph Clay1, José M. Orenday-Barraza, MD2, María José Cavagnaro MD2, Leah Hillier MD CCFP (SEM)3, Leeann Qubain1, Eric John Crawford MD MSc(c) FRCSC4, Brandon Hirsch MD5, Ali A. Baaj MD2, Robert A. Ravinsky MDCM MPH FRCSC5

1 University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
2Department of Neurosurgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
3Department of Family Medicine & Community Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
4Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
5Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.

CLINICAL TOOLS

Abstract: Low back pain (LBP) is one of the most common presenting complaints in the primary care setting with significant economic implications and impairment of quality of life. Effective treatment of LBP can frequently be delivered in the primary care setting. Knowledge of common pain generators and recognition of pain patterns based on the history and physical exam helps guide the treatment of LBP without the need for excessive resource utilization. The majority of patients presenting with LBP can be confidently managed with targeted conservative management; when this fails further investigation may be warranted. Part 2 of this review focuses on imaging and diagnosis of LBP, as well as a detailed review of treatment modalities.
Key Words: low back pain, imaging, diagnostic interventions, treatment.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Patients presenting with lumbar-related complaints, in the absence of red flags or neurological deficits, can safely undergo a course of conservative treatment prior to ordering imaging studies.
Nonsurgical treatment modalities that can be attempted in patients with LBP include oral medications, topical medications, passive modalities, active physical therapy and cognitive interventions.
Diagnostic interventions such as selective nerve root blocks, diagnostic facet joint injections, medial branch blocks and provocative discography can be useful in confirming that a particular anatomical structure is a clinically relevant pain generator.
Surgery, in the absence of red flags or neurological deficits, should only be considered after the patient fails a thorough course of conservative treatment.
Images of the spine are not necessary to initiate management of mechanical low back pain; they may even be counterproductive.
When required, initial radiological evaluation of the lumbar spine involves upright plain radiographs. Further investigation may include use of MRI or CT myelography.
Diagnostic interventions can aid in establishing the dominant pain-generating anatomical structure but are not required if the patient is improving as anticipated.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, imaging, diagnostic, intervention, treatment

A Practical Guide to Managing Low Back Pain in the Primary Care Setting: Epidemiology, Pathoanatomy, Clinical Evaluation and Triage—Part 1

Teaser: 

Conner Joseph Clay1, José M. Orenday-Barraza, MD2, María José Cavagnaro MD2, Leah Hillier MD CCFP (SEM)3, Leeann Qubain1, Eric John Crawford MD MSc(c) FRCSC4, Brandon Hirsch MD5, Ali A. Baaj MD2, Robert A. Ravinsky MDCM MPH FRCSC5

1 University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
2Department of Neurosurgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
3Department of Family Medicine & Community Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.
4Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
5Department of Orthopaedic Surgery, University of Arizona College of Medicine – Phoenix, Phoenix, AZ.

CLINICAL TOOLS

Abstract: Low back pain (LBP) is one of the most common presenting complaints in the primary care setting, with significant economic implications and impairment of quality of life. Effective treatment of low back pain can frequently be delivered in the primary care setting. Knowledge of common pain generators, and recognition of pain patterns based on the history and physical exam helps guide the treatment of LBP without the need for excessive resource utilization. The majority of patients presenting with LBP can be confidently treated with targeted conservative management, frequently obviating the need for advanced imaging and diagnostic investigations.
Key Words: low back pain, mechanical low back pain, lumbar pain, degenerative disease, clinical evaluation, triage.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
The lumbar spine is designed to be both strong and flexible, but disruption or degeneration of the supporting structures of the spine can result in low back pain without major pathology.
Low back pain can be characterized into one of four pain patterns using a focused history supported by a relevant physical exam.
Lumbar spine MRI is indicated if accompanying Red Flag symptoms, such as recent systemic illness, high suspicion for tumour, or progressive/severe neurological symptoms/signs are present with the back pain.
The presence of "red flag" signs and symptoms must be carefully interpreted as a group and not individually.
Most adults will experience LBP sometime during their life.
Knowledge of common pain generators, and recognition of pain patterns based on the history and physical exam help guide treatment without the need for excessive resource utilization.
The goal of triaging LBP is to determine which cases arise from sinister pathology, and which cases can be safely managed conservatively.
Diagnostic investigations and specialist referral are warranted only when there is suspicion of a specific disease process that would be managed differently than mechanical LBP.
When clearly identified, the four LBP pain patterns should be treated in the primary care setting before undergoing advanced imaging.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, low back pain, mechanical low back pain, lumbar pain, degenerative disease, clinical evaluation, triage
Disclaimer: 
Disclaimer at the end of each page