Exam of Thoracic & Lumbar Spine Flashcards
What is the medical term for abnormal increased concavity of the thoracic spine?
lordosis
What is the medical term for abnormal increased convexity of the lumbar spine?
kyphosis
What composes mechanics of the back?
vertebrae & IV discs
ligaments
large superficial & deep intrinsic muscles
Bony structures of spine
vertebral body supports weight bearing
posterior vertebral arch encloses the spinal cord
Inspection of spine
assess of erect position of head, neck & back
for smooth, coordinated neck movements
ease of gait
What to pay attention to during inspection
spinous processes (C7 & T1) paravertebral muscles on either side of midline iliac crests posterior superior iliac spine line drawn above PSIS (crosses SP of L4)
Back flexion muscles
psoas major, psoas minor, quadratus lumborum, ab muscles attaching to anterior vertebrae, int & ext obliques
Back extension muscles
deep intrinsic muscles of back (erector spinae & transversospinalis groups)
Back rotation muscles
ab muscles, intrinsic muscles of back
Back lateral bending muscles
ab muscles, intrinsic muscles of back
Spinal column ROM
if any of ROM produces pain or tenderness, w/ radiation into leg, proceed to neuro testing of lower extremities
Palpation of spine
SP of thoracic & lumbar spines
TP of thoracic & lumbar spines
paraspinal muscles of thoracic & lumbar spines
TART findings
Step off
occurs in spondylolisthesis (forward slippage of 1 vertebra) may compress spinal cord
if 1 SP is unusually prominent in relation to 1 above it
Sacroiliitis
tenderness over sacroiliac joints (palpate over PSIS)
Ankylosing spondylitis
tenderness over sacroiliac joints (palpate over PSIS)
Percussion of T&L spine
pain w/ percussion occurs in vertebral osteoporotic fractures, infection & malignancy
Straight leg test
+ test with pain
low specificity but high sensitivity for diagnosis of radiculopathy due to disc herniation (usually need other signs like muscle weakness or dermatome sensory loss)
Crossed straight leg test
+ test is presence or worsening of radicular pain radiating into contralateral leg (esp between 30-60 degrees)
indicates lumbosacral radiculopathy and/or sciatic neuropathy
Thoracic kyphosis
increases w/ aging
pearl of scoliosis
lateral & rotatory curvature of spine brings head back to midline
unequal shoulder height
unequal height of iliac crest
deformity of thorax w/ forward bending
unequal height of iliac crest
unequal leg lengths
scoliosis
hip abduction or hip adduction
listing of trunk to 1 side w/ herniated lumbar disc
Muscle spasms or ankylosing spondylitis
persistence of lumbar lordosis
What is common to OA & ankylosing spondylitis?
decreased spinal mobility
Cauda Equina syndrome
condition of spinal nerve root compression by massive disc protrusion, fracture/trauma or tumor
presentation: low back pain, bladder or bowl dysfunction, sensory loss of perineum & decreased anal sphincter tone, bilateral sciatica & leg weakness
EMERGENT management & surgical decompression
