Basic Spine MSK Exam

Question 1

spondylolysis

Answer 1

fracture of pars interarticularis (spottie dog)

Question 2

spondylolisthesis

Answer 2

anterior displacement of one vertebrae on another

Question 3

basic spine exam do what?

Answer 3

assess appearance, palpate, check ROM, basic strength, basic reflexes, basic sensory exam, any special tests

Question 4

appearance: looking for what?

Answer 4

symmetry, scoliosis, scapular winging, cervical/lumbar lordosis, thoracic kyphosis, cafe au lait spots (neurofibromatosis), atrophy

Question 5

palpate what/where?

Answer 5

spinous processes/interspaces, paraspinal muscles, cervical spine (cervical musculature) lumbar spine

Question 6

cervical spine landmarks?

Answer 6

hyoid bone- C3
thyroid cartilate- C4-5
first cricoid ring- C6
most prominent spinous process- C7

Question 7

lumbar spine landmarks?

Answer 7

top of iliac crest, L4-5

PSIS, S2

Question 8

cervical spine ROM?

Answer 8

rotation: 70
flexion: 45
extension: 55
sidebending: 40

Question 9

lumbar spine ROM?

Answer 9

flexion: 75
extension: 30
lateral bending: 35
rotation

Question 10

pathologic reflexes (signs of upper motor neuron process)

Answer 10

hoffman: passive rapid flexion of distal middle finger (+ = flexion of thumb, index finger)
babinski: stroking sole of foot resulting in great toe extension and toe spreading

Question 11

special tests?

Answer 11

straight leg raise, femoral stretch test, spurling test (cervical spine extension etc = ipsi radicular stx), Lhermitte (electric shock sensation in limbs with cervical flexion)

Question 12

lumbar strain history + etiology

Answer 12

axial low back pain after acute injury. muscle disruption from excessive stretch/tension

Question 13

lumbar strain exam + treatment

Answer 13

localized muscle tenderness, reduced ROM. no imaging, relative rest, NSAIDs

Question 14

osteoarthritis (facet joints) history + etiology

Answer 14

axial low back pain w gradual onset. d/t gradual degenerative changes/OA to facet joints. > 55

Question 15

osteoarthritis (facet joints) exam + treatment

Answer 15

nonspecific, pain provoked with active extension, relieved with flexion. no imaging, NSAIDs, mild analgesics. PT.

Question 16

radiculopathy history + etiology

Answer 16

pain & possible numbness/weakness in limb > axial spine. disc herniation more common.

Question 17

radiculopathy exam + treatment

Answer 17

SLR or Spurling +, neuro deficits (weakness, decreased reflex, reduced sensation). MRI, maybe EMG. relative rest, PT, NSAIDs

Question 18

lumbar stenosis history

Answer 18

slowly progressive back and unilateral/bilateral leg pain. shopping cart sign. differentiate from vascular claudication.

Question 19

lumbar stenosis etiology

Answer 19

narrowing of spinal canal d/t disc herniation/protrusion, ligamentum flavum thickening, osseous thickening of bone/facet joint, spondylolisthesis

Question 20

lumbar stenosis exam

Answer 20

nonspecific. possibly flexed standing posture, reduced lumbar lordosis

Question 21

lumbar stenosis treatment

Answer 21

MRI, maybe CT or EMG. NSAIDs, PT, use of walker

Question 22

cervical myelopathy history + etiology

Answer 22

pain, numbness, weakness in arms &/or legs, balance and gait difficulties, bowel/bladder dysfunction. d/t cervical canal stenosis w spinal cord compression

Question 23

cervical myelopathy exam + treatment

Answer 23

arm and/or leg weakness, UMN signs. MRI, surgical decompression. no role for nonoperative treatment.

Question 24

compression fracture history + etiology

Answer 24

usually sudden thoracic or lumbar pain, often little to no trauma. osteoporosis relation in older patients. younger consider malignancy, multiple myeloma. 1/3 asymptomatic.

Question 25

compression fracture exam

Answer 25

tender over spinous processes, paraspinals. worse with lumbar flexion. better with lumbar extension. normal neuro exam.

Question 26

compression fracture treatment

Answer 26

imaging: plain x-rays, poss MRI or CT. DEXA scan for osteoporosis. different if malignancy considered. bracing. PT. consider vertebroplasty

Question 27

ankylosing spondylitis history

Answer 27

onset of low back pain < age 40, insidious, better with exercise, pain at night and on waking, not improved with rest

Question 28

ankylosing spondylitis etiology

Answer 28

inflammatory spondyloarthropathy, usually sacroiliitis initially. can be assoc w uveitis, inflammatory bowel disease, psoriasis

Question 29

ankylosing spondylitis exam

Answer 29

reduced lumbar ROM, often tender to palpation over sacroiliac joints with positive joint provocative tests

Question 30

ankylosing spondylitis treatment

Answer 30

imaging: plain x-rays, earliest finding sacroiliitis. later, bamboo spine.
labs: HLAB27, CRP, sed rate.
meds: NSAIDs, possibly anti-TNF agents. PT, spine extension

Question 31

cauda equina syndrome history

Answer 31

leg pain, numbness, weakness, saddle anesthesia, bowel/bladder dysfunction

Question 32

cauda equina syndrome etiology

Answer 32

large herniated disc compressing cauda equina most common

Question 33

cauda equina syndrome exam + treatment

Answer 33

reduced or absent reflexes, weakness, decreased rectal tone. surgical emergency!