MSS18 Flashcards
Components of spine exam
Inspection
Palpation
ROM
Neuromuscular exam
Special tests
Exam related areas
Cervical Myelopathy
HX: Gradual progression, typically >50, loss of fine motor skills, gait disturbances, B/B dysfuction, motor weakness, LE numbness, weakness, pain
Exam: UMN findings, Hyperreflexia, Hoffman’s sign, positive Babinski, Lhermitt sign, Rhomberg sign, Wide base, ataxia, slow gait
Etiology: Spinal cord compression, usually gradual progression d/t osteophyte formation, spinal stenosis
Tx: surgery
Lumbar strain
Hx: axial low back pain after acute injury (lifting)
Pain is WORSE with movement, BETTER with rest
Exam: localized muscle tenderness, REDUCED ROM, normal nuero
Etiology: muscle disruption from excessive stretch
Tx: rest, NSAIDS, PT
Compression fracture
HX: usually SUDDEN onset of thoracic or lumbar pain
Exam: local tenderness, painful ROM (esp flexion), normal neuro
Image: Plain x-ray (loss in height, wedge shaped fracture), MRI or CT
Labs: check CBC, SPEP, Alk Phos, ESR (malignancy), DEX, endocrine (Osteoporosis)
Tx: NSAIDS, Bracing,
usually asymptomatic,
Associated with prolonged corticosteroid use, in younger pts consider malignancy
Cauda equina syndrome
HX: chronic back pain, new saddle anesthesia/leg pain, bowel/bladder dysfunction, weakness, numbness
Exam: decreased rectal tone, reduced or absent reflexes, weakness
Etiology: herniated disc compressing cauda equina (L3/4)
Tx: Surgical Emergency
Ankylosing spondylitis
Early: Widening of SI joints w/ sacroiliitis
Late: fusion of SI joints w/sacroilitis resulting in bamboo spine, ossification of longitudinal ligaments
HX: slow progressive back pain and stiffness. WORSE in morning and w/ prolonged activity. BETTER w/ exercise
Exam: Reduced ROM, tender over SI joint
Labs: CRP, Sed rate, HLA B27 +
TX: NSAIDS, PT, anti-TNFa if refractory to NSAIDS
Fracture
Major trauma, minor truama w/ lifting in elderly, prolonged corticosteroid use, osteoporosis, age
What is a dermatome and what are some key landmarks?
Dermatome is a region of skin innervated by somatic sensory nerve axons associated with a single DRG at a single spinal cord level.
C2: skull cap
C3: high turtleneck
C4: low collar shirt
T4: nipple
T7: xiphoid
T10: belly button
L1: inguinal canal
L4: knee
S2,3,4: sensitive
What causes Herpes Zoster?
Reactivation of previous infection of DRG or sensory ganglion by varicella zoster. Presents as a rash confined to nerve sensory distribution. Localized pain with vesicles appear 72 to 96 hours later.
How can you test the C5 myotome?
Biceps: Elbow flexion
How can you test the C6 myotome?
Extensor carpi radialis: wrist extensor
How can you test the C7 myotome?
Tricep: Elbow extensor
How can you test the C8 myotome?
Flexor digitorium profundus: distal finger flexion
How can you test the T1 myotome?
Abductor digiti minimi: little finger abduction
How can you test the L2 myotome?
Iliopsoas: hip flexion
How can you test the L3 myotome?
Quadraceps: knee extension
How can you test the L4 myotome?
Tibialis Anterior: ankle dorsiflexion
How can you test the L5 myotome?
Extensor Hallicus Longus: big toe extensor
How can you test the S1 myotome?
Gastrocnemius: ankle pantarflexor
Reflex testing
S1,2: achilles ( gastrocnemius)
L3,4: patellar (quads)
C5,6: biceps
C7,8: Triceps
What is lhermittes sign?
passitive anterior cervical flexion elicts electric like sensation.
Indicates cervial spinal cord pathology
What is Spurling’s Neck compression test?
Reproduction of radicular sxs with cervical spine extension, rotation and lateral rotation ( nerve root compression)
What is Hoffman’s sign?
Flick pt’s middle finger–> causes flexion and adduction of thumb and index finger ( UMN problem)
What is the straight leg raise?
Pt lies supine and pain is reproduced when leg is raised at 30-70 angle. (Lumbar nerve root pathology)
What is the femoral nerve stretch test?
pt is put into prone position, knee is flexed and pain is reproduced in anterior thigh. (upper lumber nerve root pathology L2-L3)
Disc herniation
Hx: Progressive pain in neck and arm, “shooting pain” down arm, numbness in arm
Pain: BETTER (C- lying; L: standing walking)/ WORSE: (C-ROM, Lumbar: sitting, bending, cough/sneeze)
Exam: Positive spurling, weak elbow extesion (C7), decreased sensation
Commonly: C6-C7 and L5-S1 (SLR +)
TX: avoid bedrest, NSAIDS, PT, Steroid injection
Spondylolysis
congenital defect of acquired stress fracture
presents with NO slippage of adjacent vertebrae.
Radiologic: Scottie dog with a collar
Spondylolisthesis
Anterior displacement of L5 body while the posterior fragment remains over S1
radiologic: Scottie dog w/ a broken neck
Facet joint arthropathy
HX: axial low back pain, gradual onset (C- worse with cervical extension; Lumbar: worse standing/ walking)
Exam: pain provoked with active extension, ,relieved with flexion
Etiology: gradual degenerative changes/OA to facet joints
TX: NSAIDS, PT, steroids if refractory
Lumbar stenosis
HX: Slowly progressive pain in back and in unilateral or bilateral LEG. (WORSE: with standing and walking specific distances) Relieved with lumbar flexion, sitting
Exam: no focal findings, neuro exam normal. Check pulses!
Etiology: narrowing of spinal canal
Tx: PT, walker, NSAIDS, steroids, Surgery
