CLIN SKILLS: Back Exam Flashcards

1
Q

general MSK back exam process

A
  • introduction
  • cervical spine: inspection, palpation, move
  • thoracolumbar spine: inspection, palpation, move, special tests
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2
Q

inspection for cervical and thoracolumbar spine

A
  • general appearance
  • muscle bulk
  • abnormality
  • skin
  • swelling
  • deformity e.g. lordosis, kyphosis, scoliosis
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3
Q

palpation for cervical and thoracolumbar spine

A
  • cervical bony landmarks: C2, C6, C7, spinous processes, intervertebral discs, facet joints (2-3cm lateral to spinous processes)
  • thoracolumbar bony landmarks: T2 (superior angle of scapula), T7 (inferior angle of scapula), L4/L5 (iliac crests), spinous processes, intervertebral discs, facet joints (2-3cm lateral to spinous processes)
  • effusion
  • swelling
  • tenderness
  • temperature
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4
Q

cervical spine (neck) movements ROM

A
  • Flexion (chin to chest) - 45˚
  • Extension (look up and back) - 45˚
  • Lateral flexion (touch shoulder with ear) - 45˚
  • Rotation (look over shoulder to left and right) - 70˚
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5
Q

thoracolumbar spine (back) movements ROM

A
  • Flexion (touch toes w/o bending knees) - 75-90˚
  • Lateral flexion (reach sideways, L then R) - 20-25˚
  • Extension - 20-30˚
  • Rotation (while sitting, twist around to each side) - 30-40˚
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6
Q

list the special tests for thoracolumbar spine

A
  • schober’s test
  • nerve stretch tests: straight leg raising, bragard’s, cross straight-leg raising, femoral stretch
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7
Q

schober’s test

A
  • assesses lumbar flexion to test for ankylosing spondylitis
  • find PSIS (S2) and mark 5cm below and 10cm above
  • ask Pt to bend forward to touch toes (flexion), measure distance b/n 2 lines. Distance should increase by 5cm or more (i.e. 15 + 5 = 20)
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8
Q

straight leg raising (lasegue test)

A
  • high sensitivity, low specificity
  • Pt lying supine, cup heel in hand and passively flex the hip to 90 deg w/ straightened leg
  • positive if pain radiates to calf, pain in back or glutes ONLY is a false positive.
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9
Q

bragard’s test

A
  • perform straight leg raising test, stop raising leg when painful
  • lower extended leg slightly to relieve pain, dorsiflex ankle
  • pain should be relieved
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10
Q

cross straight-leg test

A
  • high specificity, low sensitivity for diagnosing lumbosacral radiculopathy (L5-S1)
  • raise the leg similar to the straight leg test, any pain will be in the OPPOSITE side
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11
Q

femoral stretch test

A
  • Pt lying prone, flex one knee
  • may cause pain in anterior/medial thigh by stretching femoral nerve roots L2-L4
  • pain aggravated by hip extension
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