MOD3- Spine Flashcards
The Spine Musculoskeletal Examination of the Neck & Back
Vertebral Anatomy
– Cartilaginous Joint
– Total of 24 vertebrae
– Bony surfaces separated by fibrocartilaginous discs
– Vertebral Anatomy- Flexibility of the spine related to angle of the articular facet joints relative to the plane of the vertebral body
EVERYTHING SO CLOSE TOGETHER-NERVE, LIGS, BONE. THUS COMMON NECK AND BACK PAIN(80%). LIKE EUROPE/ASIA FIGHTING
What is significant about L5-S1?
– Sharp posterior angle at the lumbosacral junction to the immovable sacrum increases risk for disc herniation and subluxation of
Inspection of Spine
– From side: inspect for normal/abnormal lordosis and kyphosis
– From back: inspect alignment of shoulders and waist (asymmetry may indicate scoliosis or muscle spasm)
– Inspect skin for dimpling, masses or lesions
– Inspect while patient bends forward, look for rib hump (scoliosis affecting the thoracic spine)
– Kyphosis-
chronic fx, degenerative
– Scoliosis- Corkscrew-
type curvature of spine greater than 10deg. 80% idiopathic. Neuro etc
R thoracic 65deg angle. Term related to where angle meets. Curve is pushing to L
L thoraciic 65, curve pushing to R
– Spina Bifida
Folic acid deficiency
– Menignmyelocele vs.
– Meningocele-
1.-Spinal cord in sac
2. No spina cord in sac
Open neural tube defect
Occulta
is a closed spinal dysraphism. May indicate underlying vertebral defects
– Cauda Equina Syndrome- L5/S1.
L2 start of cauda equina SX: Low back tenderness Bilateral leg weakness Saddle anesthesia Anal Reflex Loss of rectal tone Bilateral dermatomal sensory loss Decreased or absent lower extremity DTRs
Cervical Spine
– Inspection: posture, spinal curvatures (side), alignment (posterior), skin markings or masses
– Palpation: spinous processes, facet joints C2-C7; paravertebral muscles, C7-T1 usually most prominent
– Spasms of paravertebral muscles- Torticollis
ROM of Cervical Spine
Flexion Extension Rotation: look over shoulder Lateral Bending: ear to shoulder Be sure to stabilize shoulders to accurately assess the cervical spine motion Source of pain, always ask
– Examining the Thoracic Spine
–
Inspection from the side and back
– Inspection with the patient bending forward, evaluate for kyphosis
– Palpation of the spinous processes and paravertebral muscles
– Feel for step-offs when going down the spinous processes, may indicate spondylolisthesis or forward subluxation of vertebrae
– Examining the Lumbar Spine–
Inspect from side and back
Palpate:
spinous processes
paraspinal muscles
sacroiliac joints(dimpling overlying the PSIS)
sciatic nerve/notch and piriformis muscle(buttock)
–
Special test: Straight Leg Raise
generally negative
Sciatic nerve impingement
– With the patient sitting or supine, passively raise the affected leg. 35-70deg sciatic, neuropathic
– If pain and radiculopathy, positive test
– Indicates sciatic nerve impingement
.
Piriformis syndrome
is a common cause of buttock and posterior leg pain. patients typically experience symptoms in all 5 toes (multiple dermatomes) rather than in lateral toes (S-1 radiculopathy) or medial toes (L-5 radiculopathy), as is commonly seen in patients with herniated lumbar discs
