11. Spine exam Flashcards
normal curvature of the spine
The cervical and lumbar spines should be lordotic with a balanced thoracic kyphosis.
what is scoliosis
abnormal, lateral (sideways) curvature of the spine
why should you look for cafe au lait spots during a spine exam
neurofibromatosis type 1 is associated with Scoliosis
How many of each vertebrae?
Think about meal times… 7am, 12pm, 5pm
Cervical - 7
thoracic - 12
Lumbar - 5
Sacrum (5, fused)
Coxyx (4, fused)
At what vertebral level is the end of the spinal cord?
L1 usually
A palpable step at the lumbosacral junction
indicates spondylolisthesis.
for tenderness over the sacroiliac joints
ankylosing spondylitis
normal range flexion of cervical spine
chin able to touch chest
normal range cervical extension
50°
what may limit cervical lateral flexion and lateral rotation
painful conditions or in a fused spine
how to measure lateral flexion
Ask the patient to stand erect with hands at their sides and feet
30cm apart. Measure the distance from the fingertips to the floor. Ask the patient to flex maximally to the side and re-measure the distance from the fingertips to the
floor.
The difference between the two measurements is recorded as the amount of lateral flexion (normal >10cm).
normal lateral flexion
> 10cm
normal range of rotation spine
normal range of rotation is 40°
what part of the spine is responsible for rotation
almost entirely thoracic. The lumbar
contribution is <5°.
causes percussion tenderness
infection, fractures and
neoplasia
what specifal test may you do if you suspect ankylosing spondylitis
Assess chest expansion at the level of the fourth intercostal space (normal = 3-5cm). This may be reduced in ankylosing spondylitis.
how to perform schobers test
mark L5 spinous process
mark 10cm above this
difference between these marks in erect and flexed position = outcome of lumbar flexion
how to perform modified schobers
mark PSIS
A second line is marked 5 cm below the first line.
A third line is marked 10 cm above the first line.
should increase from 15cm to at least 20cm for normal
o/e signs of osteoporotic vertebral fracture
Loss of height: vertebral osteoporotic fractures of lead to compression of the spinal vertebrae hence a reduction in overall length of the spine and thus the patient becomes shorter
Kyphosis (curvature of the spine)
Localised tenderness on palpation of spinous processes at the fracture site
examination findings cervical spondylosis
Reduced range of movement of neck (in all directions)
Poorly localised tenderness
Signs of radiculopathy (most commonly affecting nerve roots C5 to C7)
Unilateral neck, shoulder or arm pain, paraesthesia, or hyperaesthesia
Diminished arm reflexes (triceps: C7, biceps: C5/C6, supinator: C5/C6).
A small number (<0.1% of patients with cervical spondylosis) of patients with associated acute myelopathy can develop quadriplegia.
