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
2
Q
inspection for cervical and thoracolumbar spine
A
- general appearance
- muscle bulk
- abnormality
- skin
- swelling
- deformity e.g. lordosis, kyphosis, scoliosis
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
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˚
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˚
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
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)
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.
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
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
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