Spinal examination Flashcards
What are the key components of a spine examination?
Inspection, palpation, range of motion testing, neurologic examination, and provocative tests.
Why is it important to examine gait during a spine examination?
Gait abnormalities can indicate neurological disorders, muscle weakness, or joint pathology affecting the spine.
What does an antalgic gait suggest?
A painful condition causing the patient to shorten the stance phase on the affected side.
What are the potential causes of a Trendelenburg gait?
Weakness of the hip abductor muscles due to superior gluteal nerve injury, hip arthritis, or lumbar radiculopathy.
How does the Spurling maneuver help diagnose nerve root compression?
By applying axial load while rotating and extending the neck, it can reproduce radicular symptoms, confirming foraminal stenosis or nerve root impingement.
What differentiates a positive Lhermitte sign from other spinal cord compression tests?
Lhermitte sign produces a shock-like sensation radiating down the spine and limbs upon extreme neck flexion, indicating cervical myelopathy or multiple sclerosis.
What are the indications of sacroiliac joint dysfunction?
Localized pain in the sacroiliac joint with palpation, positive FABER test, and pain during activities involving hip rotation.
What does a positive Schober’s test indicate?
Reduced lumbar flexion, suggesting conditions like ankylosing spondylitis or other inflammatory spinal diseases.
What is the purpose of the Babinski test?
To assess corticospinal tract integrity; an upward extension of the great toe suggests an upper motor neuron lesion.
What neurological condition is indicated by sustained ankle clonus?
Upper motor neuron disease such as cervical myelopathy, multiple sclerosis, or spinal cord injury.
How does the Hoffmann’s test relate to cervical myelopathy?
It tests for hyperreflexia; involuntary thumb flexion following a flick to the middle finger suggests upper motor neuron dysfunction.
Why is Bragard’s test performed after a positive straight leg raise?
To differentiate between true radicular pain (increased with dorsiflexion) and other causes of leg pain.
What is the anatomical basis of the femoral stretch test?
It evaluates upper lumbar nerve root tension by extending the hip while flexing the knee, which stretches the femoral nerve.
How does cervical radiculopathy differ from cervical myelopathy?
Radiculopathy involves nerve root compression causing unilateral pain and sensory loss, while myelopathy affects the spinal cord, leading to bilateral motor and sensory dysfunction.
What factors contribute to lumbar spinal stenosis?
Degenerative changes such as hypertrophy of the ligamentum flavum, disc bulging, and osteophyte formation leading to canal narrowing.
Which nerve roots are tested by the patellar reflex?
L2-L4, primarily assessing the function of the femoral nerve.
What is the significance of asymmetrical deep tendon reflexes?
Asymmetry may indicate focal nerve root compression, spinal cord lesions, or peripheral neuropathy.
What is the dermatome distribution for the upper extremities?
C5 (shoulder), C6 (lateral forearm & thumb), C7 (middle finger), C8 (ulnar hand), T1 (medial forearm), T2 (proximal medial arm & axilla).
What is the difference between myotomes and dermatomes?
Myotomes refer to muscle groups innervated by a single spinal nerve, while dermatomes refer to skin areas supplied by a single spinal nerve.
What are the clinical signs of a lumbar disc herniation at L4-L5?
Weakness in great toe extension, sensory loss over dorsum of foot, and pain radiating along the L5 dermatome.
What findings suggest an L5-S1 disc herniation?
Weakness in ankle plantarflexion, diminished Achilles reflex, and pain radiating to the sole of the foot.
What is the clinical relevance of the Oxford muscle strength grading scale?
It assesses voluntary muscle strength from 0 (no contraction) to 5 (full strength against resistance).
Why are long tract findings important in spinal examination?
They indicate upper motor neuron pathology, such as spinal cord compression or myelopathy.
What conditions may present with a positive Romberg test?
Dorsal column dysfunction (e.g., vitamin B12 deficiency, tabes dorsalis) or vestibular dysfunction.
How do you differentiate between radicular and referred pain?
Radicular pain follows a dermatomal distribution due to nerve root compression, whereas referred pain arises from visceral or musculoskeletal sources and does not follow dermatomes.
What structures are affected in cauda equina syndrome?
The lumbosacral nerve roots (L2-S5), causing bowel/bladder dysfunction, saddle anesthesia, and lower limb weakness.
What urgent action is required for suspected cauda equina syndrome?
Immediate MRI and surgical decompression to prevent permanent neurological deficits.
What is the purpose of facet joint palpation?
To assess for tenderness or pain indicative of facet joint arthropathy, which can cause localized back pain and stiffness.
What does a positive Gaenslen’s test indicate?
Sacroiliac joint dysfunction or inflammation when the test reproduces pelvic pain.
