Chapter 12 - Physical Examination of the Spine

Question 1

Spurling maneuver is very specific for nerve root compression where?

Answer 1

foraminal or lateral recess

Question 2

What does the Lhermitte sign indicate?

Answer 2

(electric shock like sensations down the spinal cord) - indicates direct compression of the spinal cord

can be positive in myelopathy (highly SPECIFIC, not very sensitive), multiple sclerosis, or B12 deficiency

Question 3

Straight leg raise

Answer 3

highly SENSITIVE for nerve root compression at L4-5, L5-S1 but not very specific

Question 4

Crossed straight leg raise

Answer 4

SLR causes symptoms in CONTRAlateral leg. highly SPECIFIC for a contralateral L4-5 or L5-S1 nerve root compression

Question 5

Waddell Signs

Answer 5

If >=3 of 5 of these are present, suggests non–organic pain

superficial tenderness
simulation
overreaction
regional disturbances (non-dermatomal)
distraction

Question 6

C5 - motor, sensory innervation, reflex (if present)

Answer 6

Deltoid, Bicep, sensation to lateral arm proximal to elbow, brachial reflex

Question 7

C6 - motor, sensory innervation, reflex (if present)

Answer 7

Biceps, brachialis, wrist extensors, radial side of the forearm sensation, brachioradialis reflex

Question 8

C7 - motor, sensory innervation, reflex (if present)

Answer 8

Triceps, wrist flexors, finger EXTENSORS, sensation to the MIDDLE FINGER, triceps reflex

Question 9

C8 - motor, sensory innervation, reflex (if present)

Answer 9

Interossei, finger flexors

Question 10

Sensory level at nipple line

Answer 10

T4

Question 11

Sensory level at umbilicus

Answer 11

T10

Question 12

L1 - motor, sensory innervation, reflex (if present)

Answer 12

no motor (small contribution to iliopsoas), sensory innervation to the iliac crest, cremasteric reflex

Question 13

L2 - motor, sensory innervation, reflex (if present)

Answer 13

iliopsoas (femoral n.), hip adductors (obturator n.), sensory innervation to the anterior and inner thigh, cremasteric reflex

Question 14

L3 - motor, sensory innervation, reflex (if present)

Answer 14

contributes to knee extension through quadriceps (also L4) (femoral n.), anterior thigh, medial thigh, medial knee sensation, no reflex

Question 15

L4 - motor, sensory innervation, reflex (if present)

Answer 15

tibialis anterior (deep peroneal n), sensation to lateral thigh, anterior knee, medial leg to inside of great toe, patellar reflex

Question 16

L5 - motor, sensory innervation, reflex (if present)

Answer 16

Tibialis posterior (tibial n.), EHL (DPN), EDL (DPN), Hamstrings (tibial) & gluteus max (inf. gluteal n.), Gluteus medius (sup. gluteal n.), lateral leg and dorsal foot sensation, no reflex

Question 17

S1 - motor, sensory innervation, reflex (if present)

Answer 17

Gastroc-soleus (tibial n.), Peroneals (SPN), posterior leg and lateral foot sensation, achilles reflex

Question 18

S2 - motor, sensory innervation, reflex (if present)

Answer 18

FHL, FDL (tibial n), plantar foot, no reflex

Question 19

Positive babinski

Answer 19

Upgoing great toe, and lesser toe splaying