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Dor musculoesquelética na coluna lombar

Last reviewed: 18 Jun 2025
Last updated: 26 Oct 2023

Summary

Definition

History and exam

Key diagnostic factors

  • obesidade, estresse e comorbidades psiquiátricas
  • história de dor lombar prévia
  • irradiação da dor não se estende além do joelho
  • ausência de sintomas de alerta
  • ausência de febre, flutuação, sensibilidade extrema à palpação
  • exames sensitivos, motores e dos reflexos tendinosos profundos dentro dos limites normais
  • teste negativo de elevação da perna estendida em linha reta ou cruzada
Full details

Other diagnostic factors

  • dor incômoda, em facada, lacerante, ardente ou elétrica associada a espasmos musculares
  • ausência de dor na flexão ou alívio na extensão
  • escoliose ou cifose
  • teste de FABER (flexão, abdução e rotação externa do quadril), Gaenslen ou Schober negativos
Full details

Risk factors

  • obesidade
  • história familiar de doença degenerativa do disco
  • flexibilidade musculotendinosa deficiente e postura anormal
  • estresse e comorbidades psiquiátricas
  • idade mais avançada
  • sexo feminino
  • atividades físicas e ocupacionais pesadas
  • tabagismo
  • posição ortostática por tempo prolongado
  • níveis de vitamina D
Full details

Diagnostic tests

1st tests to order

  • diagnóstico clínico
Full details

Tests to consider

  • ressonância nuclear magnética (RNM) da coluna lombar
  • radiografia da coluna lombar
  • tomografia computadorizada (TC) da coluna lombar
  • mielografia
  • Hemograma completo
  • velocidade de hemossedimentação (VHS)
  • proteína C-reativa
  • urinálise e cultura
  • hemoculturas
  • cintilografia óssea com radionuclídeos
  • eletromiografia (EMG)
Full details

Treatment algorithm

ACUTE

lombalgia aguda e subaguda (≤12 semanas)

ONGOING

dor lombar crônica (>12 semanas)

dor lombar recorrente

Contributors

Authors

Andrew Sherman, MD, MS

Professor and Vice Chair

Department of Physical Medicine & Rehabilitation

University of Miami Miller School of Medicine

Miami

FL

Disclosures

AS declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Jennifer Baima, MD

Staff Physiatrist

Orthopedic and Arthritis Center

Brigham and Women's Hospital

Chestnut Hill

MA

Disclosures

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

Disclosures

AGC declares that he has no competing interests.

References

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.

Key articles

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

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.Full text  Abstract

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

Reference articles

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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  • Patient information

    Dorsalgia: perguntas a fazer ao seu médico

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