rygsmerter (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Basisoplysninger<a title="National Klinisk Retningslinje: Ikke-kirurgisk behandling af nylig opstået lumbal nerverodspåvirkning (lumbal radikulopati). Sundhedsstyrelsen 2016" data-url="https://www.sst.dk/da/udgivelser/2016/lumbal-nerverodspaavirkning-ikke-kirurgisk-behandling" data-value="National Klinisk Retningslinje: Ikke-kirurgisk behandling af nylig opstået lumbal nerverodspåvirkning (lumbal radikulopati). Sundhedsstyrelsen 2016" data-type="other-reference" href="https://www.sst.dk/da/udgivelser/2016/lumbal-nerverodspaavirkning-ikke-kirurgisk-behandling"><sup>1</sup></a><sup>,</sup><a href="https://www.sst.dk/-/media/Udgivelser/2016/NKR-lænderygsmerter/Endelig-NKR_lænderyg---med-Forside---til-hjemmesiden.ashx?la=da&amp;hash=A1CD9459AAD6BF0E4DB8EE5B0C2585F78A295336 " data-type="other-reference" data-value="SST 2016, National Klinisk Retningslinje for behandling af nyopståede lænderygsmerter" data-url="https://www.sst.dk/-/media/Udgivelser/2016/NKR-lænderygsmerter/Endelig-NKR_lænderyg---med-Forside---til-hjemmesiden.ashx?la=da&amp;hash=A1CD9459AAD6BF0E4DB8EE5B0C2585F78A295336 " title="SST 2016, National Klinisk Retningslinje for behandling af nyopståede lænderygsmerter"><sup>2</sup></a><sup>,</sup><a href="https://www.sst.dk/-/media/Udgivelser/2017/NKR-lumbal/NKR-Lumbal-Spinalstenose-13,-d-,10,-d-,17.ashx?la=da&amp;hash=66D4F4702895589AB1610CDFC9E14FA755A1AFBB " data-type="other-reference" data-value="SST 2017: National Klinisk Retningslinje for behandling af lumbal spinalstenose" data-url="https://www.sst.dk/-/media/Udgivelser/2017/NKR-lumbal/NKR-Lumbal-Spinalstenose-13,-d-,10,-d-,17.ashx?la=da&amp;hash=66D4F4702895589AB1610CDFC9E14FA755A1AFBB " title="SST 2017: National Klinisk Retningslinje for behandling af lumbal spinalstenose"><sup>3</sup></a></h2>
<h3>Definition</h3>
<ul>
    <li>Rygsmerter kan inddeles i nyopst&aring;ede og l&aelig;ngerevarende rygsmerter</li>
    <li>Akutte (nyopst&aring;ede) rygsmerter har varighed under 6 uger </li>
    <li>Kroniske (l&aelig;ngerevarende) rygsmerter har varighed over 12 uger </li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Er en af de almindeligste kontakt&aring;rsager i almen praksis </li>
    <li>Livstidspr&aelig;valens er 60-80 %, mens den &aring;rlige incidens er op til 45 %<a href=" " data-type="journal-reference" data-value="Speed C, Low back pain. BMJ 2004;328: 1119-21" data-value-piped="Speed C|Low back pain.|BMJ|2004|328|1119-21|15130982" data-url="reference-link" data-pubmedid="15130982" title="Speed C, Low back pain. BMJ 2004;328: 1119-21"><sup>4</sup></a> </li>
    <li>Alder
    <ul>
        <li>Hyppigst mellem 35 og 55 &aring;r</li>
    </ul>
    </li>
    <li>K&oslash;n
    <ul>
        <li>Kvinder og m&aelig;nd er lige udsatte </li>
        <li>Under og efter svangerskab er omkring en femtedel af kvinderne plaget af rygsmerter</li>
    </ul>
    </li>
    <li>Social- og sygeudbetalinger
    <ul>
        <li>Ryglidelser er den st&oslash;rste enkeltdiagnose for social -og sygeudbetalinger, og st&aring;r for n&aelig;sten 15 % af langtidssygemeldingerne og mere end 10 % af f&oslash;rtidspensionerne</li>
    </ul>
    </li>
</ul>
<h3>Diagnostisk udredning</h3>
<ul>
    <li>Grov inddeling af &aring;rsager til akutte rygsmerter:
    <ul>
        <li>Uspecifikke l&aelig;nderygsmerter (80-90 %) </li>
        <li>Nerverodsaffektion (5-10 %) </li>
        <li>Andre og mulige alvorlige &aring;rsager, ikke-mekaniske (&lt; 1 %)</li>
    </ul>
    </li>
    <li>Afventende udredning?
    <ul>
        <li>De fleste bliver spontant raske i l&oslash;bet af de f&oslash;rste uger. Omfattende udredning er gerne uhensigtsm&aelig;ssig i den mest akutte fase </li>
        <li>Ogs&aring; majoriteten af patienter med lumbale rodsmerter bliver spontant raske, 70 % i l&oslash;bet af 2-4 uger </li>
    </ul>
    </li>
    <li>Alarmsymptomer
    <ul>
        <li>Hvilesmerter, konstante smerter, smerter som tiltager og torakale smerter </li>
        <li>Almensymptomer, feber og v&aelig;gttab </li>
        <li>Traume</li>
        <li>Kendt kr&aelig;ftsygdom</li>
        <li>Kendt osteoporose</li>
        <li>Brug af steroider, immunsuppressiva, alkohol- og stofmisbrug </li>
        <li>Udbredte neurologiske udfald, evt. deformitet i kolumna </li>
        <li>Udtalt morgenstivhed i mere end 1 time, h&oslash;j SR </li>
        <li>Alder under 20 eller over 55 &aring;r</li>
        <li>Nylig spinalpunktur (unders&oslash;gelse af v&aelig;sken fra rygmarvskanalen)</li>
        <li>Nyopst&aring;ede vandladningsproblemer eller anden alvorlig progredierende neurologisk udfald</li>
    </ul>
    </li>
</ul>
<h3>Hvorfor henvender patienten sig?</h3>
<ul>
    <li>De f&aelig;rreste med akutte ryg-gener s&oslash;ger l&aelig;ge </li>
</ul>
<h3>Diagnostiske faldgruber</h3>
<ul>
    <li>Kr&aelig;ftsygdom </li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-kode</h3>
<p>[ICD10] </p>
<h2>Differentialdiagnoser</h2>
<h3>
<a href="~/link.aspx?_id=74E03C59199940A0B4E188E5C2758423&amp;_z=z">Akut lumbago</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>&Aring;rsagen kan v&aelig;re vertebrogen, diskogen eller muskul&aelig;r </li>
        <li>Resultat af kropsvrid, overbelastning, direkte traume, fald </li>
        <li>Degenerative forandringer hos &aelig;ldre</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Hyppigst i aldersgruppen 35-55 &aring;r </li>
        <li>Udg&oslash;r 80-90 % af patienterne med akutte rygsmerter</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Akut start, tidligere episoder </li>
        <li>Smerter eller ubehag lokaliseret til lumbosakralkolumna med eller uden udstr&aring;ling til s&aelig;deregionen eller diffust til l&aring;ret </li>
        <li>Smerten varierer, den er ofte mindre, n&aring;r patienten er&nbsp;i ro</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>God almentilstand </li>
        <li>Ingen neurologiske udfald</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>I akutfasen som regel ingen</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=74E03C59199940A0B4E188E5C2758423&amp;_z=z">Kronisk lumbago</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Muskul&aelig;r insufficiens, degeneration af diskus, midtstillet prolaps eller facetledsartrose</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Hyppig</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Recidiverende eller kroniske lave rygsmerter </li>
        <li>Ofte sammensat smertebillede</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Ingen specifik patologi, specielt ingen neurologiske udfald</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>Afh&aelig;nger af sygdomsbilledet, men differentialdiagnostisk kan r&oslash;ntgen, CT v&aelig;re aktuelt</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=BA77007FD5454D78BF5B5701D82C0135&amp;_z=z">Lumbale rodaffektioner, iskias</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Diskusprolaps med tryk mod nerver</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Udg&oslash;r 1-5 % af patienter med akutte rygsmerter</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Ofte akut start </li>
        <li>Udstr&aring;lende smerter og par&aelig;stesier, som f&oslash;lger dermatomet til nedenfor kn&aelig;et </li>
        <li>Med eller uden rygsmerter - underbensmerterne som regel v&aelig;rre </li>
        <li>Oftere hvilesmerter, forv&aelig;rring ved hoste og nysen</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Motoriske og/eller sensoriske tegn p&aring; ensidig rodaffektion </li>
        <li>Over 90 %&nbsp;har udfald i L4, L5 eller S1 </li>
        <li>Positiv Lasegues test (sensitivitet &gt; 80 %, specificitet &lt; 30 %)</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>MR eller CT</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=F69469A4F6B44C6AAF4A998FFBE0CB82&amp;_z=z">Kompressionsbrud</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Opst&aring;r som regel hos personer med generaliseret osteoporose </li>
        <li>Under halvdelen kan berette om udl&oslash;sende traume</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Hyppigst blandt &aelig;ldre kvinder</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Akutte, vedvarende rygsmerter</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Smerter ved bev&aelig;gelse og evt. ogs&aring; i hvile</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>R&oslash;ntgen bekr&aelig;fter osteoporose og fraktur</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=2B3022F9A5604E188E7E032EDBB010FC&amp;_z=z">Bechterews sygdom</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Er en inflammatorisk tilstand som hovedsageligt afficerer rygskelet, men ogs&aring; led og ekstraartikul&aelig;re strukturer </li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Forekommer hyppigere, og debuterer tidligere hos m&aelig;nd end kvinder </li>
        <li>Pr&aelig;valens er ca. 1-2 promille i den voksne befolkning, og incidensen er 3-400 nye tilf&aelig;lde per &aring;r i Norge</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Gradvist tiltagende smerter og stivhed i l&aelig;nderyggen </li>
        <li>Smerten er ofte lokaliseret til hele rygs&oslash;jlen og iliosakralled </li>
        <li>Natlige smerter og morgenstivhed dominerer. Symptomerne lindres ofte op ad dagen og ved fysisk aktivitet</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Nedsat bev&aelig;gelighed i et eller flere afsnit af ryggen </li>
        <li>Palpations&oslash;mhed over torntappene og iliosakralled </li>
        <li>Affektion af senef&aelig;ster i h&aelig;l, siddeknude og hoftekam</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>Kun 1-2 % af alle som er HLA-B27-positive, har sygdommen </li>
        <li>R&oslash;ntgen vil efter nogen tids sygdom bekr&aelig;fte diagnosen</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=6AB4877EB60C4AD09C3FAC771904179E&amp;_z=z">Spondylolyse, spondylolistese</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Defekt i hvirvelbuen, medf&oslash;dt eller som f&oslash;lge af tr&aelig;thedsbrud (spondylolyse) </li>
        <li>Tilstanden giver symptomer f&oslash;rst og fremmest hos unge (15-19 &aring;r), og er associeret med idr&aelig;t med hyperekstension, rotation og torsion (jf. kastere, h&aring;ndbold) </li>
        <li>Glidning (spondylolistese) forekommer hos 30-80 %</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Pr&aelig;valens er ca. 7 % i den voksne befolkning (spondylolyse), men kun 10 % af disse har symptomer</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>L&aelig;nderygsmerter med udstr&aring;ling til glutealmuskulaturen og til l&aring;r </li>
        <li>Smerterne forv&aelig;rres gerne op ad dagen</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Smerterne kan forv&aelig;rres ved hyperekstension men ikke ved fleksion </li>
        <li>Et-bens hyperekstension af kolumna, st&aring;ende eller liggende, kan udl&oslash;se smerte</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>R&oslash;ntgen kan bekr&aelig;fte tilstanden</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=D03A2A34FDAC4A3DB243AFD8F6175A70&amp;_z=z">Scheuermanns sygdom</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Mest sandsynlig skyldes lidelsen en aseptisk knoglenekrose i hvirvellegemet med reduceret blodforsyning til v&aelig;kstzonen </li>
        <li>Nekrosen er mest udtalt fortil og f&oslash;rer til, at hvirvellegemerne f&aring;r en kileform </li>
        <li>Hos 70 % er forandringerne lokaliseret til torakalkolumna</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Opst&aring;r almindeligvis i pubertetsv&aelig;kstspurten </li>
        <li>Er hyppigere hos drenge end piger</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>De fleste med moderate forandringer i torakalkolumna har ingen smerter, mens en st&oslash;rre andel med lumbal affektion kan have smerter</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>&Oslash;get kyfose i torakal- eller torakolumbalkolumna</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>Diagnosen bekr&aelig;ftes ved r&oslash;ntgen</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=2DB7758B2B4E4C82B5AD9964909D028F&amp;_z=z">Skoliose</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Krumning i frontalplanet </li>
        <li>Skelnes mellem strukturelle (oftest idiopatisk) og ikke-strukturelle skolioser (oftest anisomeli)</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Pr&aelig;valens er 3 %, men behandlingskr&aelig;vende skolioser udg&oslash;r kun 3 promille </li>
        <li>Idiopatisk skoliose er langt hyppigere blandt piger</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Skoliose patienter har normalt ikke flere rygsmerter end andre </li>
        <li>M&aring;ske kan de lettere f&aring; sekund&aelig;r slidgigt i ryggen</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Ved strukturel skoliose vil fremoverb&oslash;jning vise asymmetri, torsion i ryggen</li>
        <li>Ved ikke-strukturel skoliose for&aring;rsaget af anisomeli vil skoliosen ikke v&aelig;re tilstede i siddende stilling</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>R&oslash;ntgen bekr&aelig;fter og klassificerer tilstanden</li>
    </ul>
    </li>
    <li>Indikation for behandling af den idiopatiske adolescente skoliose afh&aelig;nger bl.a. af sk&aelig;vheden m&aring;lt som Cobbs vinkel. Ved konservativ behandling med korset kan nightbrace anvendes i stedet for full-time brace, men anbefalingsstyrken er svag, idet der kun er enkelte prospektive unders&oslash;gelser med anvendelse af nightbrace<a href="https://www.ortopaedi.dk/wp-content/uploads/2016/10/KKR-Scoliose.pdf " data-type="other-reference" data-value="Kort Klinisk Retningslinje fra Dansk Ortopædisk Selskab 2016 vedrørende valget mellem natkorset eller døgnkorset ved adolescente idiopatiske scolioser." data-url="https://www.ortopaedi.dk/wp-content/uploads/2016/10/KKR-Scoliose.pdf " title="Kort Klinisk Retningslinje fra Dansk Ortopædisk Selskab 2016 vedrørende valget mellem natkorset eller døgnkorset ved adolescente idiopatiske scolioser."><sup>5</sup></a></li>
</ul>
<h3>
<a href="~/link.aspx?_id=7D3EA50DDC2E4035B6A28D62167D5280&amp;_z=z">Spondylose</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Degenerative forandringer i rygs&oslash;jlen, hovedsageligt i disci</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Findes hos de allerfleste over 40 &aring;r, men kun et f&aring;tal har symptomer </li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Spondylose er ofte ikke forbundet med s&aelig;rlige ryg-gener </li>
        <li>Lumbal spondylose kan give smerter som forv&aelig;rres ved fysisk belastning </li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Evt. nedsat bev&aelig;gelighed, ellers gennemg&aring;ende normale kliniske fund </li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>R&oslash;ntgen bekr&aelig;fter diagnosen</li>
    </ul>
    </li>
</ul>
<h3>
<a href="~/link.aspx?_id=7E0B7340303E4D7282E3D9E2FD46BBB3&amp;_z=z">Spinalstenose</a> </h3>
<ul>
    <li>&Aring;rsag
    <ul>
        <li>Skyldes som regel degeneration af disci og facetled med forkalkninger, som giver trange forhold for rygmarv eller nerverod </li>
        <li>Medvirkende &aring;rsager kan v&aelig;re spondylolistese, tidligere brud, rygoperation</li>
    </ul>
    </li>
    <li>Forekomst
    <ul>
        <li>Optr&aelig;der almindeligvis hos &aelig;ldre personer over 60 &aring;r</li>
    </ul>
    </li>
    <li>Symptomer og tegn
    <ul>
        <li>Rygsmerter og morgenstivhed, udstr&aring;lende smerter, par&aelig;stesier og kraftsvigt relateret til aktivitet </li>
        <li>Kardinalsymptomet er reduceret gangdistance </li>
        <li>Smerten lindres typisk, n&aring;r patienten b&oslash;jer sig forover</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Lasegues-test er sj&aelig;ldent positiv </li>
        <li>Motoriske udfald og bortfald af patellarefleksen er et hyppigt fund</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>MR vil bekr&aelig;fte diagnosen</li>
    </ul>
    </li>
</ul>
<h3>Andre og sj&aelig;ldne &aring;rsager</h3>
<ul>
    <li>Svulst
    <ul>
        <li><a href="~/link.aspx?_id=FEA337568D6743A3B6DAE50693FED1CA&amp;_z=z">Myelom</a> </li>
        <li>Metastase </li>
        <li>Spinal tumor</li>
    </ul>
    </li>
    <li>Inflammatorisk sygdom
    <ul>
        <li><a href="~/link.aspx?_id=422A648683274385AE4336D863341A05&amp;_z=z">Polymyalgia reumatika</a> </li>
        <li>Reiters syndrom </li>
        <li><a href="~/link.aspx?_id=01B73EDAEA6749029D805E9C5B9E687E&amp;_z=z">Psoriasis</a> </li>
        <li>Tarmsygdom (<a href="~/link.aspx?_id=7C3C6EF3B3BE4C7AA66DC32DA809FE83&amp;_z=z">Crohn</a>, <a href="~/link.aspx?_id=62540B9A858E40508D36FB82EDDEDD59&amp;_z=z">ulcer&oslash;s kolit</a>)</li>
    </ul>
    </li>
    <li>Infektion
    <ul>
        <li>Purulent diskit</li>
    </ul>
    </li>
    <li>Metabolisk knoglesygdom </li>
    <li>
    <a href="~/link.aspx?_id=5022C6009DAA4F739414DE007C6B5F16&amp;_z=z">Pankreatit</a> </li>
    <li>
    <a href="~/link.aspx?_id=E2AFE0134DBD4525ABA2C968A8DA7C52&amp;_z=z">Ulcus perforans</a> </li>
    <li>
    <a href="~/link.aspx?_id=F4FCDC4BC93747BAB9A9B384DDBDE7D9&amp;_z=z">Pyelonefrit</a> </li>
    <li>
    <a href="~/link.aspx?_id=6771FF7CB941461CB25A59F21BBC1677&amp;_z=z">Prostatit</a> </li>
    <li>
    <a href="~/link.aspx?_id=86C8023AEBC4402C8FC45B351C4B6490&amp;_z=z">Nyresten</a> </li>
    <li>
    <a href="~/link.aspx?_id=919B9AA6E522440090E8C0FA83079D12&amp;_z=z">Herpes zoster</a> </li>
    <li>
    <a href="~/link.aspx?_id=097177364DA84C79931EC09A189661C3&amp;_z=z">Endometriose</a> </li>
    <li>
    <a href="~/link.aspx?_id=4719A6BB2B29490499CC90EC00AA633F&amp;_z=z">Aortaaneurisme</a> </li>
</ul>
<h2>Sygehistorie</h2>
<h3>Centrale elementer</h3>
<h4>Akutte rygsmerter</h4>
<ul>
    <li>Tidligere ryggener?
    <ul>
        <li>Forl&oslash;b, behandling</li>
    </ul>
    </li>
    <li>Aktuelle anfald
    <ul>
        <li>Hvordan debuterede generne? </li>
        <li>Hvordan har tilstanden udviklet sig?</li>
    </ul>
    </li>
    <li>Smerterne?
    <ul>
        <li>Konstante? </li>
        <li>Hvilesmerter? </li>
        <li>Hvad lindrer? </li>
        <li>Hvad provokerer? </li>
        <li>Smertens karakter? </li>
        <li>Smertens intensitet?
        <ul>
            <li>Behov for medicin? </li>
            <li>Arbejdsevne?</li>
        </ul>
        </li>
        <li>S&oslash;vnbesv&aelig;r </li>
        <li>Udstr&aring;lende smerter?
        <ul>
            <li>Hvilken lokalisation? </li>
            <li>Ved hoste og nysen?</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Neurologiske udfald?
    <ul>
        <li>Kraft og f&oslash;lesans? </li>
        <li>Fungerer vandladning og aff&oslash;ring normalt?</li>
    </ul>
    </li>
    <li>Almensymptomer?
    <ul>
        <li>Tegn p&aring; underliggende sygdom?</li>
        <li style="text-align: left;">Nylig spinalpunktur eller operaton med spinal- eller epidural an&aelig;stesi?</li>
    </ul>
    </li>
</ul>
<h4>Kroniske rygsmerter</h4>
<ul>
    <li>Sygehistorien ved akutte rygsmerter har ogs&aring; relevans ved kroniske gener </li>
    <li>Lokalisation
    <ul>
        <li>Diffus udbredelse kan v&aelig;re tegn p&aring; somatisering </li>
        <li>Afgr&aelig;nsede smerter er oftere udtryk for organisk lidelse</li>
    </ul>
    </li>
    <li>Tidligere episoder
    <ul>
        <li>Hyppighed? </li>
        <li>Varighed? </li>
        <li>Behandling og effekt af denne?</li>
    </ul>
    </li>
    <li>Natlige smerter, langvarig morgenstivhed? </li>
</ul>
<h2>Klinisk unders&oslash;gelse</h2>
<h3>Generelt</h3>
<ul>
    <li>Grundig unders&oslash;gelse b&oslash;r foretages ved mistanke om underliggende sygdom og langtrukken tilstand - jf. nedenfor </li>
    <li>Ved akutte rygsmerter, afklar:
    <ul>
        <li>Det segmentale niveau for tilstanden </li>
        <li>Om der er tegn til nerverodsudfald </li>
        <li>Om der b&oslash;r foretages supplerende unders&oslash;gelser snarligt</li>
    </ul>
    </li>
    <li>Ved kroniske rygsmerter
    <ul>
        <li>Fors&oslash;g at stille en patoanatomisk diagnose</li>
    </ul>
    </li>
</ul>
<h4>Inspektion</h4>
<ul>
    <li>Ankomst
    <ul>
        <li>Gangen? </li>
        <li>Hvordan bev&aelig;ger patienten sig? </li>
        <li>Kan patienten&nbsp;b&oslash;je sig forover? S&aelig;tte sig?</li>
    </ul>
    </li>
    <li>Kolumna
    <ul>
        <li>Akseforhold. Skoliose? Studeres bedst n&aring;r patienten b&oslash;jer sig fremover </li>
        <li>Bev&aelig;gelsesm&oslash;nstret ved b&oslash;jning fremover, bagover, til siden og ved rotation </li>
        <li>Registr&eacute;r asymmetrier, hvad udl&oslash;ser smerter, hvad stopper bev&aelig;gelserne
        <ul>
            <li>Ensidig reduceret sidebev&aelig;gelighed kan tyde p&aring; affektion af facetled</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Kraft
    <ul>
        <li>H&aelig;lgang (L5), t&aring;gang (S1), kn&aelig;b&oslash;jning (L4) </li>
        <li>Tegn til muskelatrofi</li>
    </ul>
    </li>
</ul>
<h4>Funktionsunders&oslash;gelser</h4>
<ul>
    <li>Hofteleddet
    <ul>
        <li>Passiv bev&aelig;gelighed </li>
        <li>Isometriske test af fleksion, udadrotation, adduktion</li>
    </ul>
    </li>
    <li>Bl&oslash;ddele i hofte og b&aelig;kken
    <ul>
        <li>Palp&eacute;r for at afd&aelig;kke lokaliserede smerter</li>
    </ul>
    </li>
</ul>
<h4>Lasegues pr&oslash;ve (strakt benl&oslash;ft test)</h4>
<ul>
    <li>Er positiv ved affektion af L5- og S1-nerverod </li>
    <li>Pr&oslash;ven regnes som positiv, n&aring;r smerter str&aring;ler distalt for kn&aelig;et, f&oslash;r benet er eleveret over 60&deg; </li>
    <li>Krydset Lasegues pr&oslash;ve gennemf&oslash;res ved l&oslash;ft af det ikke-smertefulde ben </li>
    <li>Diagnostisk n&oslash;jagtighed
    <ul>
        <li>Som unders&oslash;gelse for prolaps har vanlig Lasegues pr&oslash;ve sensitivitet p&aring; 80 % og specificitet p&aring; 30 % </li>
        <li>Krydset Lasegues pr&oslash;ve har sensitivitet p&aring; 25 % og specificitet p&aring; 90 %</li>
    </ul>
    </li>
    <li>Omvendt Lasegues pr&oslash;ve udf&oslash;res ved at ekstendere i hofte
    <ul>
        <li>Testen er positiv, hvis dette f&oslash;rer til smerteudstr&aring;ling p&aring; forsiden af l&aring;r/underben (L4-affektion)</li>
    </ul>
    </li>
</ul>
<h4>Sensibilitet, motorik og reflekser</h4>
<ul>
    <li>L4-affektion kan give
    <ul>
        <li>Smerter og sensibilitetsudfald p&aring; l&aring;rets forside og medialt p&aring; underbenet </li>
        <li>Sv&aelig;kket kvadriceps </li>
        <li>Evt. nedsat patella-refleks </li>
        <li>Lasegues pr&oslash;ve er negativ, men omvendt Lasegues pr&oslash;ve er positiv</li>
    </ul>
    </li>
    <li>L5-affektion kan give
    <ul>
        <li>Smerter og sensibilitetsudfald langs lateralsiden af l&aring;r og underben, p&aring; fodryggen, langs mediale fodrand og ud i 1. t&aring; </li>
        <li>Sv&aelig;kkede ankelekstensorer (h&aelig;lgang) </li>
        <li>Ingen refleks&aelig;ndringer</li>
    </ul>
    </li>
    <li>S1-affektion kan give
    <ul>
        <li>Smerter og sensibilitetsudfald p&aring; bagsiden af l&aring;r og underben, mod h&aelig;len og p&aring; lateralsiden af foden og ud i 5. t&aring; </li>
        <li>Sv&aelig;kkede ankelfleksorer (t&aring;gang) </li>
        <li>Sv&aelig;kket eller manglende akillessenerefleks</li>
    </ul>
    </li>
</ul>
<h3>Specielt</h3>
<h4>Mistanke om cauda equina syndrom</h4>
<ul>
    <li>Median prolaps eller l&oslash;snet prolaps som presser p&aring; cauda equina (S2-S4 udfald), hvor udfald vil kunne v&aelig;re fra en blanding af lumbale og sakrale r&oslash;dder </li>
    <li>Affektion af S2-4
    <ul>
        <li>Udstr&aring;lende bilaterale smerter og nedsat sensibilitet i ridebukseomr&aring;det (mediodorsalt p&aring; l&aring;ret og perianalt) </li>
        <li>Bl&aelig;reparese (urinretention) og eventuelt rektumparese (obstipation) </li>
        <li>Erektionssvigt</li>
    </ul>
    </li>
    <li>Omfattende affektion af b&aring;de lumbale og sakrale nerver&oslash;dder
    <ul>
        <li>Bl&aelig;re-tarmparese </li>
        <li>Omfattende sensibilitetsudfald og lammelser i benene</li>
    </ul>
    </li>
    <li>Syndromet skal h&aring;ndteres som en akut situation for at afklare behovet for hurtig kirurgisk aflastning</li>
</ul>
<h2>Supplerende unders&oslash;gelser</h2>
<h3>I almen praksis</h3>
<ul>
    <li>Blodpr&oslash;ver er sj&aelig;lden indiceret ved f&oslash;rste konsultation </li>
    <li>Aktuelle pr&oslash;ver
    <ul>
        <li>Hb, CRP, SR, HLA-B27 </li>
    </ul>
    </li>
    <li>Ved mistanke om systemsygdom
    <ul>
        <li>Kalcium, fosfat,&nbsp;basisk fosfatase,&nbsp;PSA</li>
    </ul>
    </li>
    <li>Urinunders&oslash;gelse
    <ul>
        <li>Ved mistanke om urinvejssygdom</li>
    </ul>
    </li>
</ul>
<h3>Andre unders&oslash;gelser</h3>
<ul>
    <li>Billeddiagnostik er ikke indiceret ved uspecifikke rygsmerter<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="National klinisk retningslinje for behandling af nyopståede lænderygssmerter" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="National klinisk retningslinje for behandling af nyopståede lænderygssmerter"><sup>6</sup></a>&nbsp;</li>
    <li>Husk at billeddiagnostik har lav specificitet - mange patologiske fund er uden klinisk betydning&nbsp;<a href="https://vaelgklogt.dk/anbefalinger/laenderyg">L&aelig;nderyg | V&aelig;lg Klogt (vaelgklogt.dk)</a></li>
    <li>&nbsp;<span style="white-space: pre;">	</span>"V&aelig;lg klogt" anbefaling er:&nbsp;<span>"Undg&aring; billeddiagnostisk udredning med MR-scanning eller r&oslash;ntgenunders&oslash;gelse hos patienter med nyopst&aring;ede l&aelig;nderygsmerter, n&aring;r der ikke er mistanke om alvorlig lidelse".&nbsp;</span><span>Mistanke om alvorlig lidelse omfatter tegn p&aring; infektion eller bl&oslash;dning i rygmarvskanalen, knoglebrud, cancer eller afklemning af rygmarven. Symptomer p&aring; alvorlig lidelse, s&aring;kaldte "r&oslash;de flag", er feber eller anden tegn p&aring; infektion, historik om skade eller nylig spinalpunktur (unders&oslash;gelse af v&aelig;sken fra rygmarvskanalen), nyopst&aring;ede vandladningsproblemer eller anden alvorlig progredierende neurologisk udfald&nbsp;<a href="https://vaelgklogt.dk/anbefalinger/laenderyg" data-type="other-reference" data-value="Vælg klogt anbefaling: Lænderyg" data-url="https://vaelgklogt.dk/anbefalinger/laenderyg" title="Vælg klogt anbefaling: Lænderyg"><sup>7</sup></a></span></li>
    <li>Ved vedvarende og st&aelig;rke smerter i mere end 4-6 uger
    <ul>
        <li>B&oslash;r henvisning overvejes mhp. p&aring; at vurdere, om der skal foretages CT kombineret med rtg. kolumna, alternativt MR</li>
    </ul>
    </li>
    <li>Ved nerverodsaffektion uden bedring efter 4-6 uger
    <ul>
        <li>B&oslash;r der foretages&nbsp;MR (alternativt CT). Dette prim&aelig;rt hvis operation overvejes, og patienten ikke er unders&oslash;gt tidligere </li>
        <li>Hos tidligere prolapsopererede er MR f&oslash;rstevalg</li>
    </ul>
    </li>
    <li>Ved mistanke om underliggende sygdom eller brud
    <ul>
        <li>B&oslash;r der altid foretages billeddiagnostik </li>
        <li>MR foretr&aelig;kkes </li>
        <li>CT eller r&oslash;ntgen er alternativer </li>
        <li>Evt. scintigrafi - er nyttig ved infektion, brud, svulst eller inflammation og er i tidlig fase bedre end r&oslash;ntgen. Sensitivitet 90-95 %, specificitet 70 %</li>
    </ul>
    </li>
</ul>
<h4>Oversigtsr&oslash;ntgen af kolumna</h4>
<ul>
    <li>Giver information om degenerative forandringer, spondylolistese, tidligere frakturer eller kompressionsfrakturer </li>
    <li>Skoliose - rekvirer&nbsp;st&aring;ende billeder af hele kolumna, evt. f&oslash;rst efter vurdering ved ortop&aelig;dkirurg </li>
    <li>Scheuermann - tages sidebilleder af torakalkolumna</li>
</ul>
<h4>Lumbal CT</h4>
<ul>
    <li>Giver god fremstilling af facetleddene og spondylolyse </li>
    <li>Fremstiller ogs&aring; paravertebral muskulatur</li>
</ul>
<h4>MR</h4>
<ul>
    <li>MR-skanning af kolumna lumbalis er&nbsp;mere sensitiv end CT-skanning af kolumna lumbalis&nbsp;</li>
    <li>Er bedst ved mistanke om malignitet, diskit, spinalstenose </li>
    <li>Har h&oslash;j sensitivitet for begyndende degeneration i disci eller discusprotrusion, men fundene er ofte uspecifikke </li>
    <li>Ved recidivprolaps er MR med kontrast bedre end CT for at skelne mellem arv&aelig;v og ny prolaps</li>
</ul>
<h4>Knogle- og leukocyt-scintigrafi samt PET-CT</h4>
<ul>
    <li>Bruges ved mistanke om infektion, malignitet, tr&aelig;thedsbrud</li>
    <li>Degenerative forandringer, tendinitter og aseptiske knoglenekroser vil ogs&aring; give &oslash;get optagelse</li>
</ul>
<h2>Tiltag og r&aring;d</h2>
<h3>Hvorn&aring;r b&oslash;r akut indl&aelig;ggelse eller billeddiagnostik overvejes</h3>
<ul>
    <li>Relevant traume</li>
    <li>Urinretention</li>
    <li>Flatus- / f&aelig;ces inkontinens</li>
    <li>F&oslash;leforstyrrelser i ridebuks-omr&aring;det</li>
    <li>Udbredte eller progredierende pareser</li>
    <li>Gangproblemer p&aring; grund af pareser eller cauda equina syndrom
    <ul>
        <li>Patienter med akut bl&aelig;re- eller rektumparese b&oslash;r opereres indenfor 12 timer</li>
    </ul>
    </li>
    <li>Iskiaspatienter med aftagende smerte samtidig med progredierende pareser, tegn p&aring; forv&aelig;rring af tilstanden, er i fare for varig funktionsneds&aelig;ttelse </li>
    <li>Intraktable smerter</li>
    <li>Ved underliggende sygdom
    <ul>
        <li>Cancer sygdom</li>
        <li>Osteoporose</li>
    </ul>
    </li>
    <li>Smerter ved perkussionstest</li>
</ul>
<h3>Henvisninger</h3>
<ul>
    <li>Ved vedvarende og st&aelig;rke smerter i mere end 4-6 uger eller&nbsp;manglende bedring efter 6-8 uger</li>
    <li>Henvisning til tv&aelig;rfaglig rygklinik (evt. neurokirurg, reumatolog, neurolog)</li>
    <li>Henvisning til ortop&aelig;dkirurg
    <ul>
        <li>Ved kyfose eller strukturel skoliose</li>
    </ul>
    </li>
    <li>Henvisning til reumatolog
    <ul>
        <li>Ved mistanke om Bechterews sygdom eller anden inflammatorisk sygdom</li>
    </ul>
    </li>
</ul>
<h3>Ved mistanke om inflammatorisk ryglidelse</h3>
<ul>
    <li>Form&aring;l
    <ul>
        <li>Diagnostik? Terapi?</li>
    </ul>
    </li>
    <li>Sygehistorie
    <ul>
        <li>Debut? </li>
        <li>D&oslash;gnvariation? Natlige smerter? Lokalisation? Morgenstivhed? </li>
        <li>Arvelig disposition? HLA-B27? Psoriasis? Perifere ledsmerter/h&aelig;velser? </li>
        <li>Alder over 45 - debut af inflammatorisk rygsygdom er lidet sandsynlig </li>
        <li>Effekt af tr&aelig;ning? Effekt af <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>?</li>
    </ul>
    </li>
    <li>Kliniske fund
    <ul>
        <li>Rygstatus</li>
    </ul>
    </li>
    <li>Supplerende unders&oslash;gelser
    <ul>
        <li>Hb, leukocytter, trombocytter, CRP, SR, Kreatinin, ALAT, u-stix, HLA-B27</li>
    </ul>
    </li>
    <li>Andre unders&oslash;gelser
    <ul>
        <li>Rtg. total kolumna og SI-led </li>
        <li>Hvis st&aelig;rk mistanke om aktiv inflammation, foretag ogs&aring; MR-total kolumna og SI-led</li>
    </ul>
    </li>
</ul>
<h3>R&aring;d</h3>
<ul>
    <li>De allerfleste med akutte rygsmerter bliver raske i l&oslash;bet af 1-2 uger uden behandling. Rutinem&aelig;ssig&nbsp;billeddiagnostik er ikke n&oslash;dvendigt i denne fase</li>
    <li>Ved f&oslash;rste konsultation
    <ul>
        <li>Efter n&oslash;je overvejelse gives smertelindring i form af svage <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/226500">analgetika</a>, evt. <a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/213010">NSAID</a> </li>
        <li>Tilbyd kun [DliActiveSubstance;6381;paracetamol], <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> eller <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/315123">opoider</a> i till&aelig;g til vanlig behandling til patienter med nyopst&aring;ede l&aelig;nderygsmerter efter n&oslash;je overvejelse, da der ikke er dokumenteret gavnlig effekt m&aring;lt 0-12 uger efter endt behandling</li>
        <li>Vanlig aktivitet opmuntres, og kun undtagelsesvis tilr&aring;des ro og sengeleje&nbsp; </li>
        <li>Tidlig tilbagevenden til job er god "medicin"</li>
        <li>Passive behandlingsindsatser
        <ul>
            <li>Overvej at tilbyde patienter med nyopst&aring;ede l&aelig;nderygsmerter manuel ledmobiliserende behandling i till&aelig;g til vanlig behandling</li>
            <li>Tilbyd kun akupunktur teknikker i till&aelig;g til vanlig behandling til patienter med nyopst&aring;ede l&aelig;nderygsmerter efter n&oslash;je overvejelse, da den gavnlige effekt er usikker</li>
        </ul>
        </li>
        <li>Aktive behandlingsindsatser
        <ul>
            <li>Overvej at tilbyde patienter med nyopst&aring;ede l&aelig;nderygsmerter superviseret fysisk tr&aelig;ning i till&aelig;g til vanlig behandling</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Kontrol og opf&oslash;lgning
    <ul>
        <li>For alle med f&oslash;rstegangs rygsmerter </li>
        <li>Alle som er sygemeldte </li>
        <li>Foretag en ad&aelig;kvat klinisk unders&oslash;gelse </li>
        <li>Vurd&eacute;r behovet for yderligere udredning </li>
        <li>Opstart af aktiv behandling hvis generne vedvarer - fysioterapi, kiropraktik</li>
    </ul>
    </li>
    <li>For patienter med neurogene smerter p&aring; baggrund af spinalstenose g&aelig;lder<a title="National Klinisk Retningslinje: Ikke-kirurgisk behandling af nylig opstået lumbal nerverodspåvirkning (lumbal radikulopati). Sundhedsstyrelsen 2016" data-url="https://www.sst.dk/da/udgivelser/2016/lumbal-nerverodspaavirkning-ikke-kirurgisk-behandling" data-value="National Klinisk Retningslinje: Ikke-kirurgisk behandling af nylig opstået lumbal nerverodspåvirkning (lumbal radikulopati). Sundhedsstyrelsen 2016" data-type="other-reference" href="https://www.sst.dk/da/udgivelser/2016/lumbal-nerverodspaavirkning-ikke-kirurgisk-behandling"><sup>1</sup></a>:&nbsp;
    <ul>
        <li>Der er generelt gavnlige helbredseffekter af tr&aelig;ning, men det er mest hensigtsm&aelig;ssigt at fokusere p&aring; generel konditionering for at bedre patienternes samlede helbredstilstand, da der ikke er evidens for tr&aelig;ning som behandling for neurogene smerter. Patienterne b&oslash;r l&oslash;bende revurderes og viderehenvises til kirurgisk vurdering, hvis de ikke bedres. Har symptomerne st&aring;et p&aring; igennem mere end 3-6 m&aring;neder, b&oslash;r patienterne viderehenvises direkte til kirurgisk vurdering</li>
        <li>Behandling af neurogene smerter med ledmobiliserende behandling, [DliActiveSubstance;6381;paracetamol], <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> eller <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/315123">opioder</a> kan ikke anbefales, da den gavnlige effekt er usikker, og da der er risiko for&nbsp;bivirkninger. Ledmobiliserende behandling og <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/226500">analgetika</a> i en kort periode kan overvejes, hvis der er samtidige rygsmerter<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="National klinisk retningslinje for behandling af nyopståede lænderygssmerter" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="National klinisk retningslinje for behandling af nyopståede lænderygssmerter"><sup>6</sup></a></li>
    </ul>
    </li>
    <li>For patienter med nylig opst&aring;et lumbal nerverodsp&aring;virkning (lumbal radikulopati) g&aelig;lder<a href="https://www.sst.dk/-/media/Udgivelser/2017/NKR-lumbal/NKR-Lumbal-Spinalstenose-13,-d-,10,-d-,17.ashx?la=da&amp;hash=66D4F4702895589AB1610CDFC9E14FA755A1AFBB" data-type="other-reference" data-value="SST 2017: National Klinisk Retningslinje for behandling af lumbal spinalstenose" data-url="https://www.sst.dk/-/media/Udgivelser/2017/NKR-lumbal/NKR-Lumbal-Spinalstenose-13,-d-,10,-d-,17.ashx?la=da&amp;hash=66D4F4702895589AB1610CDFC9E14FA755A1AFBB " title="SST 2017: National Klinisk Retningslinje for behandling af lumbal spinalstenose"><sup>3</sup></a>:
    <ul>
        <li>Patienter b&oslash;r opfordres til normal fysisk aktivitet frem for reduceret aktivitet i form af sengeleje</li>
    </ul>
    </li>
    <li>Der kan tilbydes &oslash;velsesterapi eller manuelle ledmobiliserende teknikker, da det ikke kan underbygges, at der er klinisk relevant forskel p&aring; de to interventioner</li>
    <li>MR-skanning b&oslash;r kun tilbydes efter n&oslash;je overvejelse, da den gavnlige effekt heraf er usikker</li>
</ul>
<h2>Illustrationer</h2>
<h3>Billeder</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=7F255A026B874B04BC43459D50AC15AB&amp;_z=z">Lumbalcolumna, side, normalt, rtg.</a> </li>
</ul>
<h3>Plancher eller tegninger</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=13351A65350B4107AF72217E35035D49&amp;_z=z">Lumbalcolumna (med prolaps), tegning</a> </li>
    <li>
    <a href="~/link.aspx?_id=1D8A64029A3044949F484B8BD6C612F0&amp;_z=z">Prolaps, tv&aelig;rsnit</a></li>
</ul>
<h3>Tr&aelig;ningsfilm for l&aelig;nderyggen</h3>
<ul>
    <li><a href="~/link.aspx?_id=E6907ACE746044D89F2AB5C1757CB471&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser</a><br>
    &nbsp;<br>
    <a href="~/link.aspx?_id=3F37EE5C2C4C4078896641E521E6506D&amp;_z=z"><img alt="Klik for at se introduktionsvideoen" src="9C5B771B780A41A19989427EB606036A-135-84" title="Klik for at se introduktionsvideoen" style="height: 84px; width: 135px;" height="84" width="135"></a><br>
    <br>
    </li>
    <li><a href="~/link.aspx?_id=D15793BECC314248B5832D9BA9CF956B&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser med arabisk tale - فيديوهات تمارين رياضية باللغة العربية</a><br>
    <br>
    <a href="~/link.aspx?_id=475FEDB6C4FC460DBE85104E216E5B65&amp;_z=z"><img alt="Klik for at se introduktionsvideoen med arabisk tale" src="737E9F0FEE87480FBBB49E2FF87F2196-135-84" title="Klik for at se introduktionsvideoen" style="height: 84px; width: 135px;" height="84" width="135"></a></li>
</ul>
<h2>Patientinformation</h2>
<h3>Hvad b&oslash;r man informere patienten om</h3>
<ul>
    <li>Akutte rygsmerter er normalt ufarlige og g&aring;r over uden behandling </li>
    <li>Undg&aring; langvarigt sengeleje, passivitet </li>
    <li>Varieret fysisk aktivitet. Det at bev&aelig;ge sig er god behandling </li>
    <li>Billeddiagnostik er ikke&nbsp;n&oslash;dvendigt i den f&oslash;rste fase&nbsp;ved uspecifikke rygsmerter</li>
</ul>
<h3>Hvad findes der af skriftlig patientinformation</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=DA335A5C65D943ED8596B2B863643622&amp;_z=z">Akutte rygsmerter</a> </li>
</ul>
<h3>Animationer</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=982CBF34ED1541DABCEF40DF31E0F463&amp;_z=z">Lave rygsmerter</a> </li>
    <li>
    <a href="~/link.aspx?_id=03F15453C5C447CE9E552B7C3054D503&amp;_z=z">Ryggens anatomi</a> </li>
    <li>
    <a href="~/link.aspx?_id=570BD8062EAC49029B81A2E526BF78D1&amp;_z=z">CT-skanning</a> </li>
    <li>
    <a href="~/link.aspx?_id=3025D95BCC19450DBCE014132FDC0BBC&amp;_z=z">MR-skanning</a> </li>
    <li>
    <a href="~/link.aspx?_id=E1AAB92264F44862A148AB95BDF7F8A0&amp;_z=z">Discusprolaps</a> </li>
    <li>
    <a href="~/link.aspx?_id=1AA22C59CBAE48F185F1EE0B592651FE&amp;_z=z">Spinalstenose</a> </li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>DSAM: Vejledning i <a rel="noopener noreferrer" href="https://www.dsam.dk/vejledninger/laendesmerter" target="_blank">diagnostik og behandling af l&aelig;ndesmerter</a></li>
    <li>V&aelig;lg Klogt . Anbefaling om l&aelig;nderyg:&nbsp;<a href="https://vaelgklogt.dk/anbefalinger/laenderyg">L&aelig;nderyg | V&aelig;lg Klogt (vaelgklogt.dk)</a></li>
    <li>V&aelig;lg Klogt. Anbefaling om opioider:&nbsp;<a href="https://vaelgklogt.dk/anbefalinger/opioider">Opioider | V&aelig;lg Klogt (vaelgklogt.dk)</a></li>
    <li>Sundhedsstyrelsen: <a rel="noopener noreferrer" href="https://www.sst.dk/da/udgivelser/2025/NKA-Brug-af-paracetamol-NSAID-og-opioider-til-behandling-af-akutte-laenderygsmerter-hos-voksne" target="_blank">National klinisk anbefaling for brug af paracetamol, NSAID og opioider til behandling af akutte l&aelig;nderygsmerter</a></li>
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