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Advanced Physical Dx > Spine > Flashcards

Spine Flashcards

1
Q

What are the red flags for serious conditions?

A
  1. Fracture
  2. Tumor infection
  3. Neurologic compromise
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2
Q

What history correlates to fracture?

A 
Major trauma (or minor trauma in elderly patient)
compression frx
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3
Q

What history correlates to tumor or infection?

A

History of cancer
Constitutional symptoms (fever/chills, weight loss)
Age over 50

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4
Q

What history correlates to neurologic compromise?

A

Cauda Equina Syndrome- rare but serious surgical emergency

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5
Q

What must be inspected for the spinal exam while the pt is standing?

A
  1. Observe Gait Very Important

2. Back alignment/deformity, position of head, shoulder & scapula, “rib hump”

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6
Q

What must be palpated on the spinal exam while the pt is standing?

A
  1. Spinous processes
  2. Paraspinal muscles
  3. Pelvis level?
  4. SI joint
    * *Check all for pain or spasm
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7
Q

What movements must be performed on the spinal exam while the pt is standing?

A
  1. Forward flexion/extension at waist and side to side bending
  2. Check for scoliosis
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8
Q

What gait test assesses S1 function?

A

Walk on toes

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9
Q

What gait test assesses L4/5 function?

A

Walk on heels

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10
Q

What are abnl gait patterns?

A
  1. Antalgic
  2. Trendelenburg
  3. Short leg
  4. Foot drop
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11
Q

What physical signs may indicate nerve root tension?

A

If pt consistently stands w/ one knee bent in spite of equal leg lengths, this may indicate nerve root tension, as knee flexion relieves the pull on the nerve root(s)

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12
Q

What physical signs may indicate prolapsed intervertebral disc causing nerve root compression?

A

List or tilt

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13
Q

Where on the spine does lordosis occur?

A

Lumbar region

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14
Q

Where on the spine does kyphosis occur?

A

Cervical region

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15
Q

What other areas of the body need to be assessed when a pt complains of back pain?

A

Hip and knee

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16
Q

Define Antalgic

A

Limp

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17
Q

What needs to be inspected on a spinal exam while seated?

A
  1. Observe patient getting on/off table

2. Assess the patient’s posture- any obvious conditions?

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18
Q

What is the landmark for S2?

A

Level of gluteus medius

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19
Q

What is the landmark for T3?

A

Spine of the scapula

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20
Q

What is the landmark for T7?

A

Inferior angle of the scapula?

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21
Q

What is the landmark for L4?

A

Hip, bottom of lat dorsi

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22
Q

What is the normal angle for the Straight leg raise test?

A

Nl angle 80-90 deg or higher in pt w/ ligament laxity

One leg at a time

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23
Q

What is a positive straight leg raise?

A

30-60 deg causes LEG pain, NOT pain in the back!!

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24
Q

What other tests are performed on the spinal exam?

A
  1. Strength testing: hip and knee
  2. Sensation
  3. Reflexes
  4. DRE: check tone and senssation
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25
Q

What does a positive SLR indicate?

A

Herniated disc
Pinched nerve
Herniated disc

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26
Q

What is the sciatic stretch test?

A

dorsiflex foot, test is positive if additional pain results

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27
Q

What test is used to assess hip or sacroiliac disease?

A

Faber’s/Patrick’s

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28
Q

Describe how Patrick’s/Faber’s test is performed?

A

With patient supine, have patient place right ankle on left knee just proximal to patella.
- Stabilize pelvis and sharply, externally rotate hip, with right knee approaching the table.
Repeat for other side.

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29
Q

What reflex tests C-5?

A

Biceps

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30
Q

What reflex tests C-6?

A

Brachioradialis

31
Q

What reflex tests C-7?

A

Tricep

32
Q

What reflex tests L-4?

A

Knee

33
Q

What reflex tests S-1?

A

Ankle

34
Q

What does the loss of anal tone/reflex indicate?

A

a lesion in S-2-3-4 reflex arc, as in cauda equina lesion

35
Q

What does babinski’s reflex test?

A

Upper Motor Neuron dysfunction

36
Q

What muscle is asst w/ L-2?

A

Psoas

37
Q

What muscle is asst w/ L-3 (L2-L3 disc)?

A

Quadriceps

38
Q

What muscle is asst w/ L-4 (L3-L4 disc)?

A

Tibialis anterior

39
Q

What muscle is asst w/ L-5 (L4-L5 disc)?

A

Ext. Hallucis

40
Q

What muscle is asst w/ S-1 (L5-S1 disc)?

A

Gastrocnemius, peroneus longus/brevis

41
Q

What muscle is asst w/ S-2?

A

Bladder Sphincter

42
Q

What muscle is asst w/ S-3?

A

Anal Sphincter

43
Q

What is clonus?

A

Repeated jerking?

44
Q

What is a positive Hoffman’s sign?

A

When the middle finger is flicked, the thumb contracts

45
Q

What is a positive flip test?

A

Extending the leg while in the sitting position causes the pt to extend back or flip backward from tension on the sciatic nerve

46
Q

When is superficial abdominal reflex assessed?

A

When spinal injury is suspected

ex. snowmobile accident

47
Q

How is the superficial abdominal reflex assessed?

A

rub by belly button, and the skin moves toward the stimulated side. Absence of response indicates spinal involvement

48
Q

What is sciatica?

A

piriformis syndrome, impingment of the nerve?

49
Q

What is scoliosis?

A 
Abnl Lateral curvature of the spine>10 degree
Prevalence 2%
Female/ male equal
Screening should start after age 6
Causes:
Idiopathic (85%)
50
Q

True/false: back pain is higher in pts with scoliosis?

A

False: back pain is not higher in pts with scoliosis

51
Q

When is scoliosis likely to progress?

A
  1. Curves in untreated adolescents with curves < 30 º at time of bony maturity are unlikely to progress
  2. Curves >50 º at maturity progress 1º per year
52
Q

When is scoliosis asst. with psychological issues?

A

Up to 19% of females with curves >40 º have significant psychological illness

53
Q

What are the sxs of scoliosis?

A
  1. Shoulders are different heights – one shoulder blade is more prominent than the other
  2. Head is not centered directly above the pelvis
  3. Appearance of a raised, prominent hip
  4. Rib cages are at different heights
  5. Uneven waist
  6. Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
  7. Leaning of entire body to one side
54
Q

What are the etiologies of lumbosacral strain?

A

History: Acute/subacute onset in low back, patient can’t get comfortable

55
Q

What are the sxs of lumbosacral strain?

A
  1. Muscle tenderness/ spasm
  2. Loss of flexion lateral bending
  3. Normal neurologic exam
56
Q

What is discogenic pain?

A

annulus of disc is injured, inflammed)

57
Q

What are the etiologies of discogenic pain?

A

Acute/subacute onset of back/buttock pain

58
Q

What are the sxs of discogenic pain?

A
  1. Worse with flexion
  2. Loss of flexion with increased pain
  3. Normal neurologic exam
59
Q

What are the etiologies of hermiated nucleus pulposus?

A

History: Acute/subacute onset of back/buttock and down-the-leg pain. May be minor trauma.

60
Q

What are the etiologies of herniated nucleus pulposus?

A
  1. Worse with flexion and cough or valsalva
  2. Localized tenderness and spasm
    • Straight leg raise (SLR)
  4. Radicular findings on neurological exam
  5. May have decreased or absence DTR and/or weakness on strength testing
61
Q

When are dx test not helpful in diagnosing spinal images?

A
  1. In the absence of red flags, not helpful in first 4 weeks of symptoms
  2. Remember that with MRI, up to 20% of asymptomatic young adults may have a demonstrated HNP!
62
Q

What percentage of pts wit ha herniated disc do not need surgery?

A

90% of pts w/ lumbar HNP get better with PT and do not need surgery!!

63
Q

What is inspected in the examination of cervical spine?

A

Scoliosis
Muscular – Torticollis
Tumors, Glands

64
Q

What is the landmark for C3?

A

Hyoid

65
Q

What is the landmark for C4/C5?

A

Thyroid

66
Q

What is the landmark for C6?

A

Cricoid

67
Q

What are the normal ROM for a young adult?

A

flexion – 50 deg
extension- 60 deg
lateral bending- 45 deg
lateral rotation- 80 deg

68
Q

What needs to be tested in the cervical spine exam?

A

Strength testing
Sensation testing
Reflex testing

69
Q

what is spurling’s test used for?

A

detect cervical spine problems

70
Q

How is spurling’s test performed?

A

Forcibly press down vertically on top of the head and lateral bend to L then R to compress the cervical nerve roots. Normally this is well tolerated. Avoid doing this test on elderly, frail individuals or patients with serious spine disease or injury

71
Q

What are the possible causes of scapula winging?

A

Causes are variable, could be trauma to muscle or nerves. Muscle injury serratus anterior or trapezius. Injury to nerves that supply those muscles.

72
Q

What is Lhermitte’s sign?

A

electric shock-like impulses transmitted down spine to lower limbs when neck is flexed

73
Q

What does a positive Lhermitte’s sign indicate?

A

Can occur with cervical spinal cord injury

74
Q

What sign can be seen in MS pts?

A

Lhermitte’s sign

Advanced Physical Dx (9 decks)

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