BACKGROUNDThe increasing trend of working from home (WFH) among workers may lead to prolonged sitting time, which is associated with increased complaints of low back pain (LBP). The lumbosacral angle (LSA) is one of the clinically important radiographic angles related to the curves commonly measured to evaluate the biomechanical factors linked with LBP. The purpose of this study was to determine the yield of radiographic LSA for diagnosing LBP among workers aged 20-70 years. METHODS An analytic cross-sectional study involving 119 participants was carried out in Trisakti University. Lumbosacral angle was measured using Ferguson’s method. Data regarding LBP symptoms, sitting duration, and sitting position were collected using a questionnaire. Sensitivity and specificity was used to describe the characteristics of LSA as a screening test of LBP. RESULTSThe subjects consisted of 66 women (55.5%) and 53 men (44.5 %). Their ages ranged from 20 to 64 years with a median age of 40.0 years. Mean LSA was 37.4 ± 7.3º, while the prevalence of LBP was 75 (63.0%). The optimal cut-off value of LSA for the prediction of LBP was 49.5% (95% CI: 0.385-0.606). The sensitivity, specificity, positive predictive value and negative predictive value of LSA in detecting LBP were 58.7%, 45.5%, 68.8%, and 43.6%. CONCLUSIONSThe radiographic lumbosacral angle has a low yield for the diagnosis of LBP among workers aged 20-70 years. Further studies are needed to confirm our results and to test the application of this measurement.
IntroductionTraumatic diaphragmatic hernia (TDH) is uncommon, being encountered in around 0.8%-8% of patients with blunt abdominal trauma. Severe comorbidities such as fractures and thoraco-abdominal or head injuries that accompany TDH, are responsible for poor prognosis and often mask diaphragmatic injury itself. Objective of this case report was to highlight rare blunt TDH case to avoid missed diagnosis leading to complications. Case descriptionSixty seven-year old man presenting with right chest pain without difficulty of breathing after falling from stairs 1 hour before hospital admission. On clinical examination, vitals were stable, but with decreased breath sounds on right lower side of chest. Patient had history of trauma from being crushed by elevator 40 years ago without any proven diaphragmatic injury. Initial erect chest X-ray findings were inhomogeneous opacity shadow on lower right hemithorax suspected to be diaphragmatic hernia and 7th right rib fracture with pleural effusion. Thorax CT scan showed herniated right lobe of liver, gall bladder, and mesenteric fat on right hemithorax causing displacement of mediastinal structures. Patient was diagnosed with delayed TDH and hemothorax caused by newly fractured rib. Patient was referred to a better-equipped facility due to the limited surgical facilities in referring hospital. ConclusionDelayed TDHs are not common, but can lead to serious consequences. Blunt TDH occurs more often on left than on right side, in ratio of approximately 3:1. Traumatic diaphragmatic hernia is sometimes diagnosed many years after traumatic event due to latent phase of disease possibly ranging from days to years.
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