back osce

Question 1

intro

Answer 1

hand hygiene, intro, explain, consent, stand pt up and have top removed (bra can stay)

Question 2

Look

Answer 2

Ask bladder dysfunction, saddle paraesthesia (caudia equina) whilst looking at anterior, lateral, and posterior view

cachexia, body habitus, pain, shoulder height symmetry, STDCAL (symmetry, tenderness, deformities, contusions, abrasions, laceration), posture, pelvic tilt, lordosis, kyphosis, scoliosis.

Question 3

Gait

Answer 3

have pt walk whilst commenting on

walk cycle-gait (unstable, waddling), posture, drop foot, limping, stride length, potential px surgical signs

Question 4

Feel

Answer 4

spinal process (point tenderness)
paraspinal muscles (spasms, heat, inflammation, tenderness)
Sacroiliac joint (dimples in sacral region/follow pelvic boarder from iliac crest) check point tenderness

Question 5

Move

Answer 5

Cervical-flexion, extension, lateral flexion (ear to shoulder without shoulder lifting) rotation

Lumber- flexion: hands on thighs, move hands to toes >45 degrees.
- extension- hands on thigh, lean back whilst you behind pt > 20 degrees
Sit pt down
Rotation- hands on shoulder and rotate

Question 6

Special test-ensure pain not muscle tightness-bilateral test

Answer 6

Slump test (seated) hands behind sacrum, chin to chest, slight pressure with your hand to back of head/neck, extend leg and passive dorsi flex ( pain from herniated disk/nerve root entrapment)

Straight leg raise (supine) raise leg to point of discomfort, slight further for pain (45 degrees will trigger), the passive dorsi flex to confirm (pain, numbness, tingling in lower back and upper leg)

Prone knee bend (prone)- passive flex knee to butt. Pain sharp shooting ? femoral nerve compression

Question 7

Sacroiliac joint cluster test - 3 positive equal positive patho-test bilaterally

Answer 7

sacral thrust (prone)- apply x 3 thrust to SIJ, positive if symptoms return

Compression (lateral)- pt lateral with knees flex at 90 degrees, injured side on bed, apply x3 thrust to iliac crest, positive if symptoms return

Distraction- (supine) apply pressure to bilateral iliac crest, positive if symptoms return

thigh thrust- hips flexed with knees elevated and foot in air, apply thrust x 3 positive if symptoms return

Gaenslen’s- one leg off bed and other leg in thigh thrust position. apply x 3 to leg off bed and to elevated knee towards chest. positive if symptoms return

Question 8

Hip- FABER FADIR

Answer 8

FABER- flexion of hip, abduction of hip joint, external rotation- have leg outward approx 45 degrees, have knee flexed with foot on opposite shin, apply pressure to knee

FADIR- flexion of hip, adduction of hip, internal rotation. Have hip flexed with knee in air across pelvis symposis, have knee flexed to 90 degrees with foot pointing outwards being supported by you at 45 degrees and apply pressure to knee pushing medially

Question 9

tone- passive and bilaterally

Answer 9

leg roll- roll legs and ensure relaxed following of foot

knee lift- lift knee and watch it drop on its own as you let it go

Ankle clonus- hip flexion, flex knee supported by you, roll foot around and suddenly dorsi flexi, move hand off foot and observe any ankle clonus

Question 10

Power-bilaterally

Answer 10

Hip flexion/extension against resistance

Hip abduction/adduction against resistance

knee extension/flexion ( have foot planted on bed) against resistance

Dorsi flexion against resistance

planter flexion against resistance

ankle eversion/inversion against resistance

greater toe flexion against resistance

Question 11

Sensations- bilaterally

Answer 11

L1 greater tronchanter/groin

L2 proximal medial thigh

L3 distal medial thigh

L4 medial aspect of upper calf

L5 dorsal aspect third toe

S1 lateral aspect little toe

Question 12

Coordination bilateral

Answer 12

heel shin test- have pt lift their leg, run their heel down their shin and lift off their leg and repeat x 5

foot tap- have pt with their leg outstretched tap your hand with their plater aspect of the foot x 5

propreception- hold side of pt great toe, demonstrate that you will have their toe up or down they will need to identify it. Then have pt close eyes and preform on each toe x 3

Question 13

reflex bilateral

Answer 13

babinskis sign- scrap end of hammer from heel along lateral end of foot around base of toes, toe scrunch is good

sit pt up

Patella reflex-nil or hyper bad

Ankle reflex- have pt cross legs (to have site exposued)