nyeri punggung bawah (lbp)

7/25/2019 Nyeri Punggung Bawah (Lbp)

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Low Back Pain(Nyeri Punggung Bawah)

RSU HAJI

SURABAYA


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Faktor Risiko

engangkat !e!an !erat !eru"ang#u"ang

$etaran

erokok %an &inu&an keras Sering &e"ahirkan

'urang aktiitas (inactie)

steo*orosis 'eturunan

'ece&asan %isertai %e*ressi


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Prea"ensi

eningkat !er%asar usia

+,- *a%a orang usia . /, thn0

+- %ari *en%u%uk *ertahun (1,,0,,,2thn) 3,- %ari *en%u%uk seu&ur hi%u*

'ronik LBP

Le!ih kurang +-


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Per"u *erhatian *a%a orang

tua

'arekteristik nyeri

A%anya tu&or2keganasan Riwayat *enyakit &e%is

Status *sikososia"


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Penye!a! LBP 4

Acute LBPLu&!ar strain or s*rain

5erte!ra" co&*ression 6racture karena

osteo*orosis

Aneuris&a aorta a!%o&ina"

Po"y&ya"gia rheu&atica


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'ronik LBPAging#re"ate% %egeneratie %isk an% 7oint

%isease8u&or

Penyakit Paget

Fi!ro&ya"gia9i66use i%io*athic ske"eta" hy*erostosis


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LBP

Nyeri *a%a kaki !erhu!ungan %engan

LBP

8rochanteric !ursitis

steoarthritis o6 the hi*

Lu&!ar cana" stenosis

Intererte!ra" %isk herniation


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:0 'arakteristik Nyeri

Lokasi "eg *ain . !ack *ain Suggests "u&!ar ra%icu"o*athy

Leg *ain &e&!erat %engan !er7a"an %an !er%iri ta*i

!erkurang %engan *osisi %u%uk s*ina" stenosis

Anterior thigh *ain u**er "u&!ar ra%icu"o*athy or hi*%isease

nset4 $ra%ua"; s"ow < %egeneratie &echanica" *ain

Su%%en an% seere < osteo*orotic co&*ression6racture0

=66ect o6 *ositiona" change 8i%ak !erkurang %engan *eru!ahan *osisi cancer

echanica" !erkurang %engan *eru!ahan *osisi


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>0 ?as*a%a th% @ancer @ancer

,0+- %ari LBP - LBP *a%a usia %iatas +,thn

3,- LBP *asien %g kanker *a%a usia 0 +,thn ?as*a%a4

Riwayat tu&or (0-) Nyeri yang konstant

Nyeri &a"a& hari yang &engganggu ti%ur(1,-)

Penurunan BB . :,C %a"a& !"n(:+-) LBP yang ti%ak !erkurang %engan *engo!atan


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@ancer (9eyo :133)

Sensitiity S*eci6icity

Age . +, ,0 ,0:

UneD*"aine%weight "oss (.+kgin /2:>)

,0:+ ,01E

Preious history o6cancer

,0: ,013

Not i&*roing with

&e%ica" care (:2:>)

,0: ,01,


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@ancer


No re"ie6 with !e%

rest

:0,, ,0E/

Insi%ious onset ,0/: ,0E>

9uration . :2:> ,0+, ,03:

Recent !ack in7ury ,0,, ,03>

8horacic *ain ,0: ,03E


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@ancer

>2 kasus kanker menimbulkan gejala LBP teruta&a4 *ayu%ara; *aru; gin7a" atau *rostate

u"ti*"e &ye"o&atersering Non s*ina" &a"ignant %iseases *resenting with

LBP Pancreatic carcino&a

Rena" ce"" cancer Intra*e"ic tu&ors Ly&*ho&a with retro*eritonea" "y&*ha%eo*athy


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Nuc"ear

e%icine

etastatic

Bone 9isease


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0 Non S*ina" e%ica"

@on%itions 9ia!etes a66ects :+- o6 a%u"ts . E+ y

Peri*hera" ascu"ar %isease

Risk o6 rena" toDicity 6ro& NSAI9s Ische&ic heart %isease an% @HF

At risk 6or rena" toDicity 6ro& NSAI9s

Una!"e to co&*"y with *hysica" thera*y

*rogra& Seere co&or!i%ity causing surgica" risk


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E0 Psychosocia" @on%itions

Stress *eker7aan 'e"ainan *siko"ogis

9e*ression AnDiety Su!stance a!use

Sosia" ekono&i


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8he Physica" =Da&ination

!serasi4S*ina" *osture (ky*hosis) %ue to erte!ra"

co&*ression Increase% &usc"e tone an% sti66ness

(unrecognie% ParkinsonGs %isease*resenting as !one *ain

Leg *ain a"ways check %ista" *u"ses (to%istinguish ascu"ar 6ro& neurogenicc"au%ication)


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Lu&!ar strain 2 s*rain(tersering)

2k 6aktor usia

At greater risk 6or stretch in7ury

Pain increase% with co&*ression 6racturesan% ky*hosis

Pain o6 a strain is usua""y acute !ut i6 %ue to

ky*hosis is usua""y gra%ua" with *ro"onge%

stan%ing; re"iee% in su*ine *osition


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5erte!ra" @o&*ression Fracture

8eruta&a *a%a wanita (osteo*orosis)

8er7a%i s*ontan atau %engan trau&a ringan

Nyeri akut %an &e&!erat %engan gerakan P"ain "atera" 6i"&s; Bone scan; or RI usua""y

%istinguishes acute 6ro& o"%er FDGs


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@o&*ression 6racture


Age . +, years ,03E ,0/:

Age . , years ,0>> ,01/

8rau&a ,0, ,03+

@orticosteroi% use ,0,/ ,011+


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Ra%iogra*h ("e6t) 5erte!ra" co&*ression 6racture

(arrow) in an e"%er"y *atient0 Bone scan (right

shows increase% u*take in the acute"y co&*resse%


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Po"y&ya"gia Rheu&atica

Nyeri ti!a#ti!a teruta&a &a"a& hari %ankekakuan *a% "eher; !ahu; *unggung %an*inggang

Usia . +,thn $iant ce"" arteritis 6oun% in E,- e&!aik %engan *engo!atan %engan

*re%nison (steroi%)


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9egeneratie %isk an% 7oint %isease

Sering

9iagnosis %engan RI or @8

@are6u" not to attri!ute LBP sy&*to&s tothese 6reuent"y asy&*to&atic an% near

uniersa" %egeneratie changes


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3/4/03

Exercise & Bed RestAdvice to stay active: Tere is no evidence tat advice to stay

active is arm!ul !or eiter acute lo" back#ain or sciatica$%

urt does not e'ual arm

(ne or t"o days o! bed rest i! necessary Ligt activity) avoiding eavy li!ting)

bending or t"isting *ie$ "alking+ ,o data on any #articular exercises


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Tera#i dan #encegaan


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3/4/03

-assage & Pysical Tera#y

Berman!aat

Perlu #enelitian lanjut karena banyak

sekali tenik massage


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3/4/03

Acu#uncture

.ata dan #enelitian masi sedikit

Belum bisa dibuktikan untuk tera#i LBP


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(ter -odalities

Back Brace/0orset/Lumbar 1u##ort:

Traction:

2njections: 2nconclusive evidence TE,1:

ot/0old:

3ltrasound:


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Pencegaan

Exercise:Aerobic) back/leg strengtening

Back braces and education about #ro#erli!ting tecni'ues are ine!!ective

4urangi BB dan mengindari merokok

nyeri punggung bawah (lbp)

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