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ORTHO > CERVICAL & LUMBAR EXAM > Flashcards

CERVICAL & LUMBAR EXAM Flashcards

1
Q

cervical ROM

A

⦁ Flexion (80-90)
⦁ Extension (70)
⦁ Lateral bending (20-45)
⦁ Rotation (70-90)

  • 50% of rotation in cervical spine is C1/C2
  • problems with C5/C6 won’t cause as many issues with cervical motion as upper cervical vertebrae
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2
Q

INSPECTION OF CERVICAL SPINE

A
  • skin -
    ⦁ looking for any previous cervical incisions (lots are done on the front - horizontal) or in the back are more vertical incisions
  • Cervical point tenderness -
    ⦁ where are they tender - lots of trigger points for cervical spine - like the trapezium or upper/mid back (myofascial pain syndrome)
  • Muscle spasms -
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3
Q

Thoracic spine held very stable by the

A

rib cage

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4
Q

SENSORY TESTING - cervical spine

A 
⦁	lateral upper arm = C5
⦁	lateral forearm / thumb = C6
⦁	middle finger = C7
⦁	ulnar border of hand / little finger = C8
⦁	medial forearm = T1
⦁	medial upper arm = T2
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5
Q

MUSCLE STRENGTH - cervical spine

A 
⦁	Deltoids (C5)    
⦁	Biceps (C5,C6)    
⦁	Wrist extension (C6,C7)    
⦁	Wrist flexors (C7)    
⦁	Triceps (C7)    
⦁	Finger extension (C7)    
⦁	Finger flexion (C8)    
⦁	Intrinsics (T1)
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6
Q

REFLEXES - cervical spine

A

⦁ Biceps = C5
⦁ Brachioradialis = C6
⦁ Triceps = C7

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7
Q

MEDIAN & ULNAR NERVE TESTS

A

⦁ Tinel’s - elbow
⦁ Tinel’s - wrist
⦁ Phalens

Most common reason for ulnar palsy = radiculopathy of the ulnar nerve at the elbow

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8
Q

Always make sure to examine the ________ when evaluating a cervical problem as they can mask each other

A

shoulder

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9
Q

SHOULDER EXAM - cervical spine

A
  • Always make sure to examine the shoulder when evaluating a cervical problem as they can mask each other

ROM

  • Flexion / extension
  • Internal /external rotation
  • Abduction / adduction
  • Supraspinatus – thumb down with arm straight out in front (Empty Can Test)
  • Subscapularis – push off on internal rotation (belly compression or lift off test)
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10
Q

upper motor neuron tests - cervical spine

A

o Hoffman’s test = flick ring finger while hand is relaxed, and watch for the index finger / thumb to trigger

o Cross Finger = check the brachioradialis reflex and watch for the index finger to trigger

o Clonus = with patient relaxed = dorsiflex the foot and feel for the foot to jerk (count how many times it beats)

o Babinski’s = run the pointed end of reflex hummar along plantar aspect of the foot and watch for the toes to go up or down

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11
Q

SPECIAL TESTS - cervical spine

A

o Spurlings Test = extension and lateral side bending of head –> radicular symptoms

o Axial Loading = compression directly down on crown of head –> radicular symptoms

o Lehrmitte’s sign = flexion of cervical spine causes electrical shocks down the spine

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12
Q

test for nerve impingement - cervical spine

A

spurling & axial load

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13
Q

tests for cord compression - cervical spine

A

lehrmitte (stenosis, tumor, MS, disc impingement)

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14
Q

PINCH & GRIP STRENGTH - cervical spine

A

⦁ trial of 3x - take average
⦁ compare right side grip strength to left side grip strength
⦁ dynamometer
⦁ pinch - between index & thumb
⦁ grip - arm out straight in front of the patient and then grip

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15
Q

LUMBAR SPINE - GAIT

A
  • walk normally - check for trendelenburg gait (hip drops - due to glut weakness) and check for antalgic gait (limited weight bearing on affected leg due to pain)
  • tip toe walking
  • heel walking
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16
Q

lumbar spine ROM

A

⦁ flexion (40-60)
⦁ extension (20-35)
⦁ lateral bending (15-20)

17
Q

lumbar spine inspection

A

⦁ skin
⦁ lumbar point tenderness
⦁ muscle spasms
⦁ trochanteric tenderness

18
Q

SENSORY TESTING LUMBAR SPINE

A 
⦁	Groin = L1
⦁	Midanterolateral thigh = L2
⦁	Distal anteromedial thigh = L3
⦁	Medial ankle / big toe = L4
⦁	Dorsum of foot / 3 toes = L5
⦁	Lateral border of foot / pinky toe = S1
19
Q

MUSCLE STRENGTH LUMBAR SPINE

A 
⦁	Hip flexors = L1 / L2 / L3
⦁	Hip adductors = L2 / L3 / L4
⦁	Quadriceps = L2 / L3 / L4
⦁	Ankle Inversion = L4 / L5
⦁	Hip Abductors = L4 / L5
⦁	EHL / toe extensors = L5
⦁	Ankle Eversion = L5 / S1 / S2
⦁	Ankle Plantarflexion = L5 / S1 / S2
20
Q

achilles tendon reflex

A

S1

21
Q

patellar reflex

A

L4

22
Q

REFLEXES - LUMBAR SPINE

A

⦁ Patellar tendon = L4
⦁ Achilles tendon = S1
⦁ Clonus
⦁ Babinski

23
Q

hip exam - lumbar spine

A
  • internal ROM
  • external ROM
  • hip flexion contractures
24
Q

CIRCULATION

A

⦁ pedal pulses
⦁ cap refill
⦁ venous stasis changes or ulcers
⦁ varicosities / spider veins

25
Q

measure circumference - lower extremities

A
  • thigh - measure mid thigh - from superior pole of the patella to same distance on each thigh
  • calf - area of maximal circumference - measure down from inferior pole of patella to same distance on each calf

usually only measure circumference on patients that have noticeable difference or weakness

26
Q

special tests - lumbar spine

A

⦁ Sitting straight leg raise
⦁ Supine straight leg raise
⦁ Femoral nerve stretch - stretch back leg - bend foot to but - thigh pain
⦁ Lower extremity circulation
⦁ Tinel’s over fibular head
⦁ repeated toe rise - checks fatigueability of gastroc
⦁ squat with single leg raise - weakness in quad due to pinched nerve

27
Q

straight leg raise is positive with a

A

herniated disc

ORTHO (15 decks)

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