Spinal Examination Flashcards
What is the general structure you should follow when carrying out a physical exam?
LOOK FEEL MOVE
What would you LOOK at when the patient is entering the room?
Gait:
- Antalgic
- High stepping
- Spastic
- Broad based
What do you LOOK for when inspecting the patient from behind?
- Muscle wasting
- Asymmetry
- Scoliosis
What do you LOOK for when inspecting the patient from the side?
- Kyphosis
- Lordosis
What do you FEEL for when palpating the spine?
- Palpate spinal processes from skull all the way down
- Note any prominences
- Repeat palpating paraspinal muscles
- Palpate SI joints (especially in patients with lower back pain)
What do you want the patient to MOVE during the examination?
C-spine
- Flexion/Extension (80)
- Rotation (70)
- Lateral flexion (45)
Lumbar spine
- Flexion/Extension
- Modified Schrober
- Lateral flexion (Hands down to knees)
T-spine (Sitting)
- Rotation
How do you carry out the modified Schrober test?
- Mark PSIS bilaterally
- Draw horizontal line between PSIS points
- Draw 10cm line extending upwards perpendicular to original line
- Get patient to bend forwards (full flexion)
* Line should extend to 15cm (+5cm from original) - Get patient to extend
* Should shorten to 8cm (-2cm from original)
What special tests should be carried out during an exam of the spine?
C-spine
- Spurling sign
L-spine
- Straight leg raise
- Lasagues
- Flex knee
- Bowstring
What is Spurling sign? & How do you elicit it?
Most sensitive nerve tension sign - looking at nerve root entrapment in the neck
- Slightly extend neck
- Laterally flex to side that is experiencing arm pain
- Apply axial load to head
+ve sign = Pain radiates down affected arm to below elbow or increase in pins and needles
How do you test sciatic nerve impingement in the lumbar spine?
- Straight leg raise
- Straighten leg
- Severity of sciatica indicated by angle in which you get to the horizontal (e.g. 10 degrees more severe than 50)
- Once pain acheived, relieve pain by dropping leg by 5 degrees
- Lasagues
* Dorsiflex ankle to stretch sciatic nerve to reproduce pain going beneath the knee - Flex knee to relieve pain
- Bowstring test (least sensitive test)
* With knee in flexion, push into superior popliteal fossa to stretch sciatic nerve and produce pain going beneath knee
How do lower motor neurone and upper motor neurone lesions present differently?
- What is Hoffman’s special reflex?
- How is it carried out?
- What is a +ve finding?
- A reflex ilicited as a sign of cervical cord compression.
- Carried out by flicking the DIPJ of the middle finger
- +ve sign = Flexion of IPJ of thumb & DIPJ of index finger
- What is the inverted radial reflex?
- How do you carry it out?
- What is a positive sign?
- Sign of cervical cord compression
- Strike brachioradialis
- +ve = Radial deviation of wrist
How do you test for clonus?
Abruptly dorsiflex ankle & hold sustained pressure
+ve sign = 5 beats+ of circular dorsiflexion & plantarflexion motion
What are the myotomes & corresponding movements in the arms?
- C5 = Shoulder abduction (Deltoid)
- C6 = Elbow flexion & wrist extension (Biceps)
- C7 = Elbow extension (Triceps)
- C8 = Long flexors
- C9 = Ab/adduction of the fingers (Intrinsics)
Recall the myotomes of the upper & lower limb
