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Advanced Physical Dx > Spine > Flashcards

Spine Flashcards

1
Q

Spinal History Red Flags

(3)

A
  1. Fracture
    • ​Trauma - remember, elderly may fx c minor tx
    • Compression
  2. ​​​Tumor/Infection
    • ​Hx cancer
    • Constitutional changes
    • > 50 yo
  3. Neuro compromise
    • ​Cauda Equina Syndrome
      • Ask about bowel/bladder function
      • **Prepare to eval rectal tone **
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2
Q

Spine-Specific Hx Questions

(5)

A
  1. Injury
    • ​Injury type
    • Mechanisms
      • violence
      • work related
  2. Pain eval (OPQRSTUVW)
  3. ADL’s *(think bathing) *
  4. Bladder/bowl function
  5. Attempted tx
    • ​OTC meds
    • Massage
    • Chiropractory
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3
Q

Spine Palpation

(4 aspects)

A

Check all points for pn/spasm while pt is standing (if possible)

  1. Spinous processes
  2. Paraspinal muscles
  3. Pelvis level
  4. SI joint
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4
Q

Neurological Components, Spinal Exam

(4 general)

A

Conduct on upper and lower limbs

  • Dermatomes
  • Reflexes
  • Pulse
  • Sensation
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5
Q

Gait Protocol

A
  1. Observe gait pattern when pt walks into room
    • ​Antalgic (limping)
    • Trandelenburg
    • Short leg
    • Foot Drop
  2. Have pt toe walk (S1)
  3. **Heel walk (L4/5) **
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6
Q

Standing Evaluation

A
  • Nerve Root Tension - pt stand c one knee bent in spite of equal leg lengths (this poisition relieves tension)
  • Prolapsed Intervertebral Disc - “List” or “tilt” may be compensatory for nerve root compression
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7
Q

Abnml Spinal Curvature

A
  • Spinally mediated (exaggerated curves)
  • Muscle weaknesses/spasm
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8
Q

Spinal Landmarks

(

A
  • T3 - spine of scapula
  • T7 - just distal to inf angle of scapula
  • L4 - Sacrospinalis
  • S2 - Gluteus medius

These are helpful for palpating spinal tenderness - you can identify potential level of injury

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9
Q

Palpation Points, Spine

(5)

A
  • Vertebral tenderness - localized vs generalized
  • Paraspinal muscles - spasm/tenderness
  • Sacroiliac joint - tenderness
  • Groin - masses/abscesses
  • Abdomen - masses/abscesses
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10
Q

Spinal ROM

A
  • Flexion/extension
  • Lateral flexion/extension
  • Rotation L/R
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11
Q

Seated Inspection, Spinal Exam

(2 aspects)

A
  1. Observe movement on/off table
  2. Assess pt posture for obvious conditions
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12
Q

Straight Leg Raise (SLR)

A
  1. Lay pt supine
  2. Passively raise 1 leg at a time up to 60 degrees (going further may introduce hamstring tightness)
  3. Note the angle @ which pn radiating down leg occurs

+ exam = sciatic pn/parasthesia/discomfort/burning c ligament laxity that may be contra or ipsilateral to SC injury

  • exam = 80-90 degrees s pn (potential tightness)
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13
Q

Sciatic Stretch Test

A
  1. Perform straight leg raise (passively flex leg from supine)
  2. Dorsiflex ankle

+ exam = additional nerve pn radiating down leg

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14
Q

Patrick’s/Faber’s Test

A

Procedure:

  1. Place pt supine
  2. Have pt place L knee just proximal to R patella
  3. Stabalize pelvis sharply, externally rotating hip to approach knee to table
  4. Repeat on other side

Results:

+ exam = hip/sacroiliac disease or injury

  • exam = normal joint mobility
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15
Q

Spinally Relevant Reflexes

(7)

A

*Perform for upper and lower extremities, respectively *

  • Biceps = C5
  • Brachioradialis = C6
  • Tricep = C7
  • Knee = L4
  • Ankle = S1
  • Anal = S2/S3/S4 reflex arc (like cauda equina syndrome)
  • Babinski = upper motor neurons
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16
Q

LE Myotomes

A
  • Psoas = L2
  • Quadriceps = L3 (L2/L3 disk)
  • Tibialis Anterior = L4 (L3/L4 disk)
  • Extensor Hallicus = L5 (L4/L5)
  • Gastrocnemius, peroneus longus/brevis = S1 (L5/S1)
  • Bladder sphincter = S2
  • Anal sphincter = S3

*Remember, move these against resistance to test each motor neuron *

17
Q

Lower Extremity Dermatomes

A

Only pay attention to left 2 pictures

18
Q

LE Nerve Dependent Eval

(motor/reflex/sensation for L4/L5/S1)

A
  • L4
    • ​Motor = tibialis anterior (inversion)
    • Reflex = patellar
    • Sensation = medial leg
  • L5
    • ​Motor = extensor hallicus (toe dorsiflexion)
    • Reflex = none
    • Sensation = dorsum of foot
  • S1
    • ​Motor = peroneus longus/breviw (eversion)
    • Reflex = achilles
    • Sensation = lateral foot
19
Q

Upper Motor Neuron Dysfunction Signs

(3 exams)

A
  1. Hoffman’s Reflex
    • ​pt seated c hand relaxed and cradled in yours
    • flick middle finger nail
    • watch for index finger/thumb flexion
  2. Babinski Reflex
    • ​pt supine
    • stroke lightly upward on plantar foot surface
    • watch great toe extension
  3. Ankle clonus
    • ​pt seated
    • dorsiflex ankle suddenly
    • observe rhythmic beating c duration and # of “beats”
20
Q

S1 Tests

(3)

A
  1. Toe walking
  2. Straight leg raise
  3. Ankle reflex test
21
Q

L4/L5 Specific Testing

A
  1. Lumbar list - *observe trunchal shift (L or R) when pt stands c feet together *
  2. Heel walking - L4
  3. Great toe extensor weakness - L5
22
Q

Flip Test

(procedure, + result)

A

Procedure

  1. Sit pt on edge of table
  2. Passively flex pt hip (c knee straightened)

Positive - pt extends or “flips” backwards, indicating sciatic tension

23
Q

Superficial Abdominal Index

(Procedure, Results, Indication)

A

Indication: perform to eval for paralysis in trauma pt

Procedure:

  1. pt supine
  2. stroke lightly towards umbilicus

Results:

  • exam = pull umbilicus towards stimulated side

+ exam = no umbilicus movement

24
Q

Piriformis Syndrome

A

Inflammation/pressure on piriformis muscle that compresses sciatic nerve and causes irritation

Often seen c wallet in back pocket

25
Q

Scoliosis

(def, prevalence, screening, cause, prognosis)

A

Def: abnl lateral spinal curvature > 10 degrees

Prevalence: 2%, M = F

Screening: starts @ age 6

Cause: 85% cases idiopathic, but usually linked to muscular abnormality

Prognosis: back pn not significantly higher, changes as follows

  1. < 30% curve at bony maturity (adolescence) = unlikely to progress
  2. > 50% curve at bony maturiy = progress 1 deg/year
  3. 19% females c curves > 40% have sig psychological illness
26
Q

Scoliosis Signs

(7)

A
  1. Uneven shoulder blade prominence
  2. Head not centered above pelvis
  3. 1 raised, prominent hip
  4. Rib cages at different heights
  5. Uneven waist
  6. Change in skin overlying spine
    • ​dimples
    • hairy patches
    • color change
  7. Unilateral leaning
27
Q

Cobb Angle

A

Measurement to quantify spinal bending in scoliosis

28
Q

Lumbosacral Strain

(hx, 3 findings)

A

Hx:

  • acute/subacute onset in low back
  • pt can’t get comfortable

Findings:

  1. Muscle tenderness/spasm
  2. Loss of flexion/lateral bending
  3. Normal neuro exam
29
Q

Discogenic (Annulus) Pain

(hx, 3 findings)

A

Hx: acute/subacute back/buttock pn

Findings:

  1. Worse c flexion
  2. Loss of flexion c inc pn
  3. **Normal neuro exam **
30
Q

Herniated Nucleus Pulposus (HNP)

(hx, 5 findings, diagnostic testing, prognosis)

A

​Hx:

  • Acute/subacute onset of back/buttock + radiating leg pn
  • +/- Minor trauma (including sneezing)

Findings:

  1. Exacerbated c flexion, cough, valsalva
  2. Localized tenderness + spasm
    • Straight leg raise
  4. Radicular findings on neuro exam
  5. Dec/absent DTR and/or weakness in strength testing

Diagnostic Studies:

  • Test = MRI
  • Indication = no change after 4 weeks of s/sx
    • 20% asymptomatic young adults will show HNP

Prognosis: 90% pts heal s surgery

31
Q

Cervical Spine Exam

(4 aspects)

A
  1. Symmetry
    • ​scoliosis
    • torticollis (muscular)
    • tumor/gland growth
  2. Landmarks
    • ​Hyoid = C3
    • Thyroid = C4/5
    • Cricoid = C6
  3. Sternum
    • ​Excavatum
    • Carinatum
  4. Muscles
    • ​SCM (torticollis)
    • Facial assymetry
32
Q

C5

(motor, sensory, reflex)

A

Motor = deltoid and bicep flexion

Sensory = skin over deltoid

Reflex = biceps

33
Q

C6 Exam

(motor, sensory, reflex)

A

Motor = bicep, extensor carpi raialis longus, extensor carpi radialis brevis flexion

Sensory = lat forearm, incld thumb and index

Reflex = brachioradialis

34
Q

C7 Neuro Exam

(motor, sensory, reflex)

A

Motor = tricep flexion, wrist flexor, finger extensors

Sensory = middle finger

Reflex = tricep

35
Q

C8 Neuro Exam

(motor, sensory, reflex)

A

Motor = interossei, finger flexors

Sensory = medial arm, 4th and 5th digits

Reflex = none

36
Q

Spurlings Test

(indication, procedure, results, caution)

A

Indication: detect cervical spine problem

Procedure:

  1. Forcibly press down on top of head
  2. Lateral bend to L then R – compressing nerve roots

Results: pain indicates nerve swelling

Caution: may cause compression fx in frail pt or serious spine dz

37
Q

Axial Load Test

(Indication, Procedure)

A

Indication: ID disk pathology

Procedure:

  1. Pt standing
  2. Push down on pt head
38
Q

Lhermitte’s Sign

(def, two causes)

A

Def: electric shock-like impulses transmitted down spine/lower limbs when neck flexed

Causes:

  • cervical cord injury
  • MS

Advanced Physical Dx (2 decks)

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