Spinal Assessment Flashcards
What are yellow flags?
Psycho-social indicators suggesting increase risk of progression to long-term distress, disability & pain - monitor & provide medical referral in near future (can affect LBP)
What questions should be included in the body chart for spinal assessment?
- Paraesthesia/anaesthesia
- Relationship between symptoms
- Clear areas, especially referral sites
Why should you ask about coughing/sneezing in agg/easing factors?
Increases inter-discal pressure
Why should you ask about sitting & standing in agg/easing factors?
Standing: More likely to be loading facet joints
Sitting: More likely to be a disc
Why is it important to ask about past history of back pain?
- Majority of patients with LBP have recurrent episodes
- Ask how many days of the year they have LBP
What are the cord signs (special question)?
- Bladder/bowel dysfunction
- Bilateral non-dermatonmal/myotomal weakness
- Altered sensation
- Difficulty walking
What are the VBI signs?
5 Ds
- Dizziness
- Diplopia (double vision)
- Dysphagia
- Dysarthria (slurred speech)
- Drop attacks
3 Ns
- Nausea
- Nystagmus
- Numb lips & tongue
What are the red flags associated with spinal assessment?
- Patient age <20 or >55 for LBP
- Significant trauma
- Resting pain, night pain, non-mechanical symptoms
- Recent unexplained weight loss
- History of cancer
- Constitutional symptoms (malaise, fever, chills, appetite changes)
- High dose steroids
- Severe, progressive or unstable neurological presentations
- Bladder or bowel dysfunction
What are the yellow flags associated with spinal assessment?
- High level of pain out of proportion to diagnosis
- Unhelpful attitudes & beliefs about pain & dysfunction (avoidance, fear of re-injury, catastrophising)
- Low mood, emotional state, anxiety, depression
- Social withdrawal, family/relationship difficulties
- Workplace/employment psychosocial issues affecting recovery
What are psychosocial factors a strong predictor of?
Chronicity
What are the patterns of movement for facet joints in the lumbar spine?
- Flexion: Open
- Extension: Closed
- Lateral flexion: Close ipsilateral side
- Rotation: Open ipsilateral side
What are the patterns of movement for the intervertebral foramen in the lumbar spine?
- Flexion: Increases
- Extension: Decreases
- Lateral flexion: Decreases ipsilateral side
- Rotation: Decreases ipsilateral side
What does back pain vs leg pain dominant indicate?
- Back pain dominant: Disc, facet, spondylosis, strains
- Leg pain dominant: Nerve root irritation, claudication
What questions should be asked to differentiate central & peripheral patterns of LBP?
- What movements make it extend peripherally
- How far peripherally does the pain extend
- What brings it back centrally
What does 5 star tissue screening consist of?
- Non-contractile tissue
- Contractile tissue
- Neurological system
- Vascular system
- Integration
What is the recommended order of testing for spinal assessment?
- Observation
- Neuro & vascular examination (safety)
- Screening other joints
- Selective tissue tensioning
- Special tests
- Biomechanical analysis (joint play)
- Functional tests
When is neurological examination indicated?
- Pain extending past shoulder or buttock from spinal region
- Altered sensation of power
What are the components of a neurological examination?
- Strength
- Reflexes
- Sensation
- Cord signs (clonus, Babinski)
What does the VBI screening test involve?
- Sustained cervical extension & rotation looking for reproduction of symptoms
- If patient has several of the VBI signs, don’t do the test
- Only for patients with subtle symptoms that may be attributed to something else
What does spinal screening include?
- Joints above & below (including shoulder & hip)
- As a minimum, AROM + OP & special test
- Establish relationship between symptoms
What does the 12th rib usually align with?
T12-L1
What does spinal palpation include?
- General temperature
- Sweating
- Swelling
- Specific tenderness/tightness of tissue
What are cervical compression & distraction used for?
Determining if there is a nerve root problem (compression = worse, distraction = better)
When should neural dysfunction tests be used?
- When patient isn’t positive for any initial neuro tests
- No signs of nerve root compression
- When patient isn’t highly irritable
- Looking for reproduction of leg pain
What are PPIVMs?
- Passive physiological intervertebral movements
- Movements the patient can produce themselves, but doing them passively and seeing what happens at each level of the spine
What are PAVIMs?
- Passive accessory intervertebral movements
- Movements the patient cannot perform actively in isolation
- Movements of joint & surrounding tissues that are necessary for full joint ROM
