MSK - Spine Flashcards
What do you look for from the side with patient standing?
1) Look for the normal spinal curves, and whether these are increased or decreased.
N.B. The cervical and lumbar spines should be lordotic. The thoracic spine should be kyphotic.
What do you look for from behind with patient standing? (3)
1) Look at the posture of head and neck
2) Look to see if it is straight or if there is a loss of symmetry or scoliosis
3) Look for any scars or sinuses
What do you feel for and what do you say before you begin? (3)
Say “I am going to feel all down your spine. Please let me know if it is tender anywhere”
1) Palpate the midline spinous processes from top downwards.
2) Feel the sacroiliac joints
3) Feel for paraspinal muscle tenderness or increased tone one side at a time, e.g. down left & up right.
What active movements do you ask for when assessing CERVICAL spine?
(all assessment here in active)
1) Flexion. Ask the patient to put chin on chest (normal 80° from neutral)
2) Extension. Ask the patient to tilt head backwards (with care) (normal 50° from neutral)
3) Lateral flexion. Ask the patient to tilt their head, bringing ear towards the shoulder (normal 45° from neutral)
4) Rotation. Ask the patient to look over alternate shoulders (normal is 80° in each direction)
What active movements do you ask for when assessing LUMBAR spine? (3)
(all assessment here in active)
1) Flexion. Ask the patient to bend to touch their toes. Record how far down the patient reaches while you measure by placing your fingers on two adjacent lumbar spinous processes.
2) Extension. Ask them to bend backwards.
3) Lateral flexion. Ask patient to bend to the side, running alternate hand down the outside of leg (keeping upright in frontal/ coronal plane)
N.B. no rotation
What is involved in the neurological part of the examination?
[1) Straight leg raise]
2) Sensation
3) Power
4) Reflexes
Describe the straight leg test and what it is used for
1) Lie the patient down as flat as possible
2) Lift the patient’s leg (with knee straight) to straight leg raise to patient’s limit (when the pain begins)
3) Then lower leg to just below limit, dorsiflex the foot. This may exacerbate the pain from a nerve root entrapment or from a prolapsed spinal disc. (Normal to reach 80°- 90° from couch.)
How do you assess sensation?
Test fine touch sensation in right and left arms and legs at the following points. Ask patient whether feels the same on each side. DERMATOMES.
- C5 – Regimental badge area /lateral antecubital fossa
- C6 - Thumb
- C7 - Middle finger
- C8 - Little finger
- T1 - Medial antecubital fossa
- T2 - Axilla
- L1 – Upper medial thigh
- L2 – Medial mid-thigh
- L3 – Medial side knee
- L4 – Medial malleolus
- L5 – Dorsal foot, first web space
- S1 – Lateral heel
- S2 - Back of thigh
What additional sensation tests can be done?
Additional (not routinely done)
•S3-S5: Rectal tone and buttock/perianal/rectal sensation (done for trauma or cauda equina syndrome)
Where are the areas of sensation for C8, T2, L5 and S2?
- C8 - Little finger
- T2 - Axilla
- L5 – Dorsal foot, first web
- S2 - Back of thigh
Where are the areas of sensation for C7, T1, L4 and S1?
- C7 - Middle finger
- T1 - Medial antecubital fossa
- L4 – Medial malleolus
- S1 – Lateral heel
Where are the areas of sensation for C5, C6, L1, L2 and L3?
- C5 – Regimental badge area /lateral antecubital fossa
- C6 - Thumb
- L1 – Upper medial thigh
- L2 – Medial mid-thigh
- L3 – Medial side knee
How do you test power?
Test right and left arms and legs. Ask the patient to pull or push against you. Note whether it is normal or weak and whether right is different from left
The specific muscle groups tested against resistance are:
- C5: Deltoid
- C6: Biceps
- C7: Triceps
- C8: Finger flexion
- T1: Finger abduction
- L1/L2: Hip flexion
- L3/L4: Quadriceps
- L5: Great toe dorsiflexion
- S1/S2: Foot plantar flexion
What are the power tests that involve the arm?
• C5: Deltoid
“Lift upper arm away from your side”
• C6: Biceps
“Bend your elbow (forearm in neutral)”
• C7: Triceps
“Straighten your elbow”
What are the power tests that involve the hand?
• C8: Finger flexion
“Bend your fingers”
• T1: Finger abduction
“Spread your fingers”
