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Dolor musculoesquelético en la zona lumbar

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 24 Sep 2025
Last updated: 02 Jul 2025

Summary

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • obesidad, estrés y comorbilidades psiquiátricas
  • antecedentes de dolor lumbar
  • la radiación del dolor no se extiende más allá de la rodilla
  • ausencia de síntomas de alarma
  • ausencia de fiebre, fluctuación, sensibilidad agudísima a la palpación
  • exámenes sensoriales, motores y de reflejos osteotendinosos profundos dentro de los límites normales
  • prueba negativa de elevación de pierna recta o cruzada recta
Полная информация

Другие диагностические факторы

  • dolor sordo, mordiente, desgarrador, de ardor o eléctrico asociado a espasmos musculares
  • ausencia de dolor con la flexión o alivio con la extensión
  • escoliosis o cifosis
  • pruebas FABER, de Gaenslen o de Schober negativas
Полная информация

Факторы риска

  • obesidad
  • antecedentes familiares de discopatía degenerativa
  • poca flexibilidad musculotendinosa y postura anormal
  • estrés y comorbilidades psiquiátricas
  • mayor edad
  • sexo femenino
  • actividades físicas y laborales intensas
  • consumo de tabaco
  • permanecer de pie por períodos prolongados
  • niveles de la vitamina D
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • diagnóstico clínico
Полная информация

Исследования, проведение которых нужно рассмотреть

  • resonancia magnética (IRM) de la columna lumbar
  • radiografía de la columna lumbar
  • tomografía computarizada (TC) de la columna lumbar
  • mielografía
  • hemograma completo (HC)
  • velocidad de sedimentación globular (VSG)
  • proteína C reactiva (PCR)
  • cultivo y análisis de orina
  • hemocultivos
  • gammagrafía ósea con radionucleidos
  • electromiograma (EMG)
Полная информация

Алгоритм лечения

Острый

dolor lumbar agudo y subagudo (≤12 semanas)

ПРОДОЛЖЕНИЕ

dolor crónico en la zona lumbar (>12 semanas)

lumbalgia recurrente

Составители

Авторы

Andrew Sherman, MD, MS

Professor and Vice Chair

Department of Physical Medicine & Rehabilitation

University of Miami Miller School of Medicine

Miami

FL

Раскрытие информации

AS declares that he has no competing interests.

Выражение благодарностей

Dr Andrew Sherman would like to gratefully acknowledge Dr Robert W. Irwin, Dr Louise Thwaites, Dr Karen Walker-Bone, Dr Joanne Borg-Stein, and Dr Philip Chiou, previous contributors to this topic.

Раскрытие информации

RWI, LT, KWB, JBS, and PC declare that they have no competing interests.

Рецензенты

Jennifer Baima, MD

Staff Physiatrist

Orthopedic and Arthritis Center

Brigham and Women's Hospital

Chestnut Hill

MA

Раскрытие информации

JB declares that she has no competing interests.

Alexios G. Carayannopoulos, DO, MPH

Interventional Spine Physiatrist

Pain Medicine Specialist

Medical Director

Spine Center

Lahey Clinic

Burlington

MA

Раскрытие информации

AGC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

American College of Radiology. ACR appropriateness criteria: low back pain. 2021 [internet publication].Полный текст

Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-30.Полный текст  Аннотация

National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. Dec 2020 [internet publication].Полный текст

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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