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      Diretriz II: diagnóstico clínico

      case-report

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          O autor discute a fisiopatologia dos sintomas causados pelas principais doenças da coluna lombar, a relação entre repouso, atividade, intensidade, ritmo circadiano, queixas sistêmicas de origem raquidiana ou extra-raquidiana, o processo doloroso lombar e sua irradiação. Em seguida, descreve o mecanismo dos achados do exame físico, principalmente os relacionados com a alteração dos movimentos fisiológicos (flexão e extensão), os decorrentes da compressão das raízes nervosas do plexo lombossacral, os sinais não-orgânicos nas lombalgias psicossomáticas e os "sinais de alerta" naquelas lombalgias de evolução atípica (com mais de quatro semanas de duração) acompanhadas de queixas sistêmicas decorrentes de tumores, infecções e/ou fraturas. Chama-se a atenção para os "sinais de alerta" amarelos, muito prevalentes nas lombalgias crônicas, em que a existência de fatores psicossociais desfavoráveis (ansiedade, depressão, somatização, litígios, insatisfação) estão presentes.

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          Diagnostic evaluation of low back pain with emphasis on imaging.

          Jeffrey G Jarvik, Richard A Deyo (2002)
          To review evidence on the diagnostic accuracy of clinical information and imaging for patients with low back pain in primary care settings. MEDLINE search (January 1966 to September 2001) for articles and reviews relevant to the accuracy of the clinical and radiographic examination of patients with low back pain. The authors reviewed abstracts and selected articles for review on the basis of a combined judgment. Data on the clinical examination were based primarily on recent systematic reviews; data on imaging tests were based primarily on original articles. Diagnostic results were extracted by one or the other author. Quality of methods was evaluated informally. Major potential biases were identified, but neither quantitative data extraction nor scoring was done. Formal meta-analysis was not used because the diagnostic hardware and software, gold standards, and patient selection methods were heterogeneous and the number of studies was small. Sensitivity for cancer was highest for magnetic resonance imaging (0.83 to 0.93) and radionuclide scanning (0.74 to 0.98); specificity was highest for magnetic resonance imaging (0.9 to 0.97) and radiography (0.95 to 0.99). Magnetic resonance imaging was the most sensitive (0.96) and specific (0.92) test for infection. The sensitivity and specificity of magnetic resonance imaging for herniated discs were slightly higher than those for computed tomography but very similar for the diagnosis of spinal stenosis. The data suggest a diagnostic strategy similar to the 1994 Agency for Health Care Policy and Research guidelines. For adults younger than 50 years of age with no signs or symptoms of systemic disease, symptomatic therapy without imaging is appropriate. For patients 50 years of age and older or those whose findings suggest systemic disease, plain radiography and simple laboratory tests can almost completely rule out underlying systemic diseases. Advanced imaging should be reserved for patients who are considering surgery or those in whom systemic disease is strongly suspected.
          Article 0 comments Cited 127 times – based on 0 reviews     Review now
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            Descriptive epidemiology of low-back pain and its related medical care in the United States.

            Emily Tsui, R Deyo (1987)
            Accurate United States data on the prevalence of low-back pain (LBP) and its related medical care would assist health care planners, policy makers, and investigators. Data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to provide such information. The cumulative lifetime prevalence of LBP lasting at least 2 weeks was 13.8%. In univariate analyses, important variations in prevalence were found by age, race, region, and educational status. Most persons with LBP sought care from general practitioners, with orthopaedists and chiropractors being the next most common sources of care. Sources of care, and in some cases therapy, varied among demographic subgroups. These data demonstrate substantial nonbiologic influences on the prevalence and treatment of LBP, and suggest an agenda for health services researchers.
            Article 0 comments Cited 125 times – based on 0 reviews     Review now
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              What can the history and physical examination tell us about low back pain?

              R Deyo, Alice Rainville, Alida Kent (1992)
              Article 0 comments Cited 121 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hamid Alexandre Cecin: Role: ND
                Journal
                Journal ID (publisher-id): rbr
                Title: Revista Brasileira de Reumatologia
                Abbreviated Title: Rev. Bras. Reumatol.
                Publisher: Sociedade Brasileira de Reumatologia (São Paulo, SP, Brazil )
                ISSN (Print): 0482-5004
                ISSN (Electronic): 1809-4570
                Publication date (Print and electronic): April 2008
                Volume: 48
                Issue: suppl 1
                Pages: 8-12
                Affiliations
                [01] orgnameUniversidade Federal do Triângulo Mineiro
                Article
                Publisher ID: S0482-50042008000700004
                DOI: 10.1590/S0482-50042008000700004
                SO-VID: ced10985-925d-4743-aa99-10deb32cd82e
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 5
                Product

                SciELO Brazil

                Categories
                Subject: Artigos Originais

                Keywords: exame clínico,fisiopatologia,sinais de alerta,sinais não-orgânicos,lombalgias,doenças da coluna lombar
                Data availability:
                Keywords: exame clínico, fisiopatologia, sinais de alerta, sinais não-orgânicos, lombalgias, doenças da coluna lombar

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