What are the causes of groin and knee pain?

Low back pain refers to pain in the lower lumbar spine, lumbosacral region or sacroiliac region. Low back pain is one of the most common health problems in China. About 65,438+00% adults have had low back pain in the past 65,438+0 years, while 50% ~ 80% adults have had low back pain in their lifetime. With the improvement of people's understanding of rheumatic diseases, especially the popularization of knowledge of spinal arthropathy, the number of people who go to the rheumatology department for low back pain is increasing day by day. Some rheumatologists tend to give priority to the diagnosis of spinal arthropathy and ignore other diseases that can cause low back pain. The author found that there are many cases misdiagnosed as spondyloarthropathy in clinic. In recent two years, there have been more than 10 cases misdiagnosed as benign and malignant tumors. It is more common to diagnose fibromyalgia syndrome as spondyloarthropathy, which not only delays the best treatment opportunity for patients, but also causes irreparable losses. 1 Grasp the causes of low back pain. Low back pain is a chronic disease state, which can be seen at any age, especially at the age of 30-50 (especially for workers who often bend over 45 degrees), and can occur in both men and women. It can be manifested as mild discomfort, severe pain, and even affect sleep. Pain can be local or diffuse; It can be dull pain, radiation pain (such as sciatica) or involved pain (caused by visceral or spinal cord diseases). It can appear slowly because of incorrect sitting posture, or suddenly because of trauma. It can last for days, weeks, months or even years. The diseases that cause low back pain can be roughly divided into three categories: mechanical low back pain, non-mechanical low back pain and low back pain caused by visceral diseases, of which the former is the most common, accounting for about 97% of the total, especially the back muscle ligament injury (70%). Followed by low back pain caused by visceral diseases (2%) and non-mechanical low back pain (1%). Mechanical and non-mechanical low back pain mainly comes from the pathological changes of spinal structure, including ligaments, facet joints, paraspinal muscles and fascia, blood vessels, fibrous rings, periosteum and spinal nerve roots, while the low back pain caused by visceral diseases is mainly caused by the innervation of the same spinal cord segment as the organ that feels pain. Low back pain caused by intervertebral disc and facet joint degeneration and spinal arthropathy only accounts for 65,438+00% and 0.3% of the total, so for rheumatologists, besides the above two factors, other diseases should be considered (see Table 65,438+0 for details). A careful understanding of the patient's clinical features, age, sex and acute onset can provide some clues for diagnosis. The most common causes of acute diseases under 45 years old are overwork, sprain or trauma. The gradual onset of lower back pain in young adults indicates potential skeletal abnormalities, such as spondyloarthropathy or spondylolisthesis; The slow onset of adolescent males highly suggests spondyloarthropathy. Tumors, osteoporotic compression fractures, spinal stenosis and aortic aneurysms are more common in the elderly over 65 years old. Spinal canal stenosis caused by hypertrophic degeneration and degenerative spondylolisthesis is more common in the elderly than in the young. Aneurysm should be suspected in the elderly with coronary heart disease or low back pain with multiple risk factors for coronary heart disease. Differential diagnosis of chronic low back pain (pain lasting more than 3 months) is usually difficult. First of all, we should make clear the nature and location of low back pain and whether the pain is radial. For example, ankylosing spondylitis is often dull or dull pain in the hip, deep sacroiliac region or inguinal region, which can radiate to the iliac crest, greater trochanter or the back of thigh, but not below the knee joint, and often wakes up in the middle of the night. Lumbar disc herniation is mostly dull pain in the lower back, which can be relieved by lying down at night. For example, when the sciatic nerve is compressed, there may be tingling or numbness radiating to the lower part of the knee joint, such as the outer leg, instep or toe. The low back pain caused by scoliosis is mostly dull pain in one side of the back, and the symptoms can be alleviated after changing the body position. The pain caused by kidney diseases is mostly persistent dull pain in the kidney area, which can radiate to groin or external genitalia. Secondly, we should distinguish between mechanical low back pain and inflammatory low back pain. The back movement limitation caused by pain, muscle tension and paravertebral muscle pain are the same characteristics of mechanical low back pain. No morning stiffness or short-term activities will aggravate mechanical low back pain. Mechanical low back pain can be seen in many diseases in table 1. Inflammatory low back pain needs to meet four of the following five items: onset age