Lumbar Spine Examination Flashcards
What is the general layout of the lumbar spine exam?
1) WIPE
2) Look
3) Feel
4) move
5) Reflexes
What do you look for on general inspection of the patient and bedside during a lumbar spine exam?
bedside : mobility aids, analgesia
Patient : alert, comfortable and well at rest
What do you look for on closer inspection during a lumbar spine exam?
Patients back:
- muscle wasting
- assymetry
- scoliosis
From side:
- normal cervical lordosis, thoracic kyphosis and lumbar lordosis.
What do you feel for in a lumbar spine exam?
1) palpate the vertebrae
2) palpate sacroiliac joints for alignment and tenderness
3) palpate the para spinal muscles for tenderness
What movements do you assess in a lumbar spine examination?
1) Lumbar flexion and extension
2) Lumbar lateral flexion (run hand down side of leg)
3) Thoracic rotation
4) straight leg raise
5) dorsiflexion of big toe
Describe how to asses lumbar flexion and extension in a spine exam?
1) place 3 fingers over the lumber spine
2) ask pt to bend forward
3) your fingers should move apart during flexion and together during extension
describe how you would assess thoracic rotation?
1) ask patient to sit facing forwards with their arms corssed in front of them,
2) ask them to twist their shoulders to one side adn then the other.
Describe how you would perform the straight leg test?
1) ask the pt to lie as flat as possible.
2) raise one leg (held in extension)
3) raising of leg may trigger pain if nerve root irritation is present (dorsiflexion will exacerbate this)
Why is it important to check dorsiflexion of the big toe?
impairment of this movement can indicate L5 nerve root problem.
What reflexes do you assess in a lumbar spine exam and what nerve roots are they testing?
- patella (L3/L4)
- ankle jerk (S1/S2)
What are your end pieces for the lumbar spine exam?
- full PNS of lower limbs
- peripheral vascular exam of lower limbs if indicated.
