Of these, four papers were relevant to the three-part question. Limit to human and English language.Ĭochrane: (bisphosphonates OR diphosphonates OR alendronate OR pamidronate) AND (fracture*) AND (pain OR analgesia*).Įighty-three papers were identified in MEDLINE, 512 in EMBASE and 98 in the Cochrane Library. OR exp pamidronate/) AND (exp pain/ OR exp analgesia/OR pain.mp. OR exp diphosphonates/OR exp alendronate/OR alendronate.mp. MEDLINE and EMBASE: exp fractures, compression/OR exp spinal fractures/OR ((spinal or vertebrae) ADJ (osteoporosis OR compression) ADJ fractures).mp.) AND (exp bisphosphonates/OR bisphosphonates.mp. MEDLINE 1950–November WEMBASE 1980–2010, Week 46 and the Cochrane Library November 2010. You have heard that some bisphosphonates relieve the pain of pathological fractures and wonder whether they do so in vertebral compression fractures. You are keen to discharge this patient but want to maintain pain control and, given the potential side effects, would prefer to avoid opiates and non-steroidals. She is mobilised and arrangements are made for her to have physiotherapy in the community. Her pain is controlled acutely with paracetamol, ibuprofen and oral morphine sulphate. Plain radiographs of her thoracic spine show osteopenic vertebrae with a wedge compression fracture of the body of T8. It will also show you the all important angels' wings exercise.In do reduce ? Clinical ScenarioĪ 72-year-old woman presents to the emergency department with severe back pain after a mechanical fall. It is described more briefly here in using the BackBlock for the upper back. The standard lumbar BackBlock routine is described here in how to do the BackBlock. Watching the downloadable video from the back pain video package at the bottom of this page will carefully take you through how to do the BackBlock for the upper back, and more importantly how to get off the Block without hurting yourself. The thoracic BackBlock procedure is described in detail in the Thoracic Spine section of the book 'Body in Action' which is available on Sarah Key Books, together with other important mobilising exercises for this part of the body. The harder surface creates an un-buckling decompressive effect on the spinal segments and interrupts the crushing bending forces, in both the thoracic and lumbar spines.Īfter a period of three months has transpired since the most recent fracture patients can then progress to using a 1.5cm book under both thoracic and lumbar spines and as soon as this becomes comfortable, using the BackBlock. The first step in conservative management of these conditions is simply spending a couple of minutes per day lying flat on the back on a carpeted floor, with a small pillow only under the head. You can read more about it in the page upper back pain with breathing. People with advanced postural kyphosis can avoid getting to the sad juncture of spontaneous fracturing by doing their own thoracic spine decompression on a daily basis. Advanced thoracic kyphosis is a common cause of breathing difficulties and pain associated with breathing. It can also be the source of great pain in the upper back and around the sides and front of the chest wall. This is a case of stooped upper back, known as a postural kyphosis a self treatment approach to manage and prevent spine compression fracturesĪpart from the possibility of fractures, a hunched upper back looks unsightly. Also, the spine is usually quite stable in the aftermath and does not require internal fixation, or any other surgical procedure. Although the pictures on MRI or X-ray can look alarming, there's often surprisingly little pain from this crush fracture. The mechanics of the injury are sufficient to crumple the bone of the front (or side) of the vertebral body. This is caused by a savage forced bending strain (usually forwards) buckling the spine down on itself at a moment of traumatic impact. Apart from the tragedy of lifetime paralysis, the spine is left mechanically unstable and usually needs surgical stabilisation.Ī typical spine compression fracture is a wedge fracture. The spine can suffer crush fractures of the vertebral bodies as well as snapping breakages of the various bony fins sprigging from the sides of the vertebrae (these are for muscle attachment) such as the transverse and spinous processes. The sorts of spinal fractures that cause paraplegia and quadriplegia (with paralysis of the legs in the former and arms and legs in the latter) involve traumatic shearing forces across the spine, transecting the soft spinal cord inside the bony column, like slicing through a sausage. T12, at high waist level, has suffered a compression fracture a wedge fracture is One Of The common spine compression fractures
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