Cervical and Lumbar Exam Flashcards
Common CCs of cervical region?
- posterior neck pain
- upper trap/shoulder pain
- pain b/t shoulder blades
- weakness
- alt in fine motor control
- numbness: very specific or very generalized
What should you observe with your pt presenting w/ cervical complaint?
always pay attention to pt’s movements and actions:
- general appearance
- abnormal pain behaviors
- mood and affect
- gait
Inspection part of exam for cervical complaint?
- skin
- posture
Palpation part of exam for cervical complaint?
- cervical pt tenderness
- muscle spasms
- lymphadenopathy
ROM testing for cervical complaint?
- flexion: 80-90
- extension: 70
- lateral bending: 20-45
- rotation: 70-90
Sensory testing in cervical region (dermatomes)?
- C5: lateral upper arm
- C6: lateral forearm
- C7: middle finger
- C8: ulnar border of hand
- T1: medial upper arm
Testing muscle strength in cervical dermatome?
- deltoids (C5): abduction of shoulder
- biceps (C5, C6): elbow extension
- wrist extension (C6, C7)
- wrist flexors (C7)
- triceps (C7): elbow etension
- finger extension (C7)
- finger flexion (C8)
- intrinsics (T1)
Special tests for Cervical region?
axial loading
foraminal compression test (spurlings):
- + if pain radiates to arm toward which head is side flexed, sig: cervical root compression
What does a + hoffman’s reflex mean?
- presence of upper motor neuron lesion from spinal cord compression
Cervical reflexes tested?
- biceps: C5
- triceps: C7
- brachioradialis: C6
Common CCs of lumbar region?
- back pain (gen horseshoe pattern)
- buttock pain
- leg pain
- weakness
- numbness/tingling
Observation part of lumbar exam?
- always pay attention to pt’s movements and actions
- general appearance
- abnormal pain behaviors
- mood and affect
Inspection part of lumbar exam?
- skin
- muscle spasms
- posture
- look for lordosis, scoliosis
Palpation part of lumbar exam?
- pt tenderness
- trochanteric tenderness
- SI jt pain
ROM testing part of lumbar exam?
- flexion: 40-60
- extension: 20-35
- lateral bending: 15-20
- rotation
Gait testing for lumbar exam?
- tip toe walking
- heel walking
- tandem gait
Sensory testing - lumbar exam?
- L1: groin
- L2: midanterolateral thigh
- L3: distal anteromedial thigh
- L4: medial ankle
- L5: dorsum of foot
- S1: lateral border of foot
Dermatomes for muscle strength of lumbar spine?
- hip flexors: L1, 2, 3
- hip adductors: L2, 3, 4
- quads: 2, 3, 4
- ankle inversion: L4, 5
- EHL, toe extensors L5
- ankle eversion L5, S1, 2
- ankle plantar flexion L5, S1, 2
L4 MRS?
- M: tibialis anterior-ankle dorsiflexion
- R: patella tendon
- S: medial aspect of foot
L5 MRS?
- M: extensor hallucis longus: great toe extension
- S: dorsum of foot
S1 MRS?
- M: peroneus longus and brevis ankle eversion
- R: achilles tendon
- S: lateral aspect of foot
Special tests for lumbar spine?
- babinski
- ankle clonus
- positive reflects presence of upper motor neuron lesion from spinal cord compression
What is supine SLR testing?
- if pain is reproduced around 40 degrees of hip flexion or less, the test is +, pain exacerbated by adding ankle dorsiflexion while leg is raised
What is the femoral nerve stretch test?
- pt lies prone w/ knee passively flexed to the thigh
- positive test = anterior thigh pain
What are you testing for w/ hip exam?
- trochanteric tenderness
- ROM
Special tests for SI jt irritation?
- compression: pt lying w/ affected side up. Hips flexed at 45 and knees flexed at 90. Both hands on iliac crest and exerts downward pressure
- distraction: pt supine and examiner stands on affected side, places hands on ASIS w/ arms crossed and applies pressure downward and laterally
- fabers: pt supine w/ examiner at side, leg of afffected side is bent at hip and knee and foot positioned on opposite knee, downward and lateral pressure is applied to knee and the affected side
