Spine Flashcards

1
Q

What do you do to start the examination?

A
Wash hands
Introduction
Identification
Consent
Exposure
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2
Q

What exposure is required for a spinal examination?

A

Pants

bra

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3
Q

What do you look for?

A

Skin
Cervical spine
Thoracolumbar spine

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4
Q

What do you look for on inspection of the skin?

A

Cafe au lait spot (neurofibroma)
Sacral dimple, hairy dimple (spina bifida)
Scarring

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5
Q

What should you feel for?

A
Tenderness in spine
Kneck (anterior, lateral, posterior)
Supraclavicular fossa
Paraspinal muscles
Sacrum
Sacroiliac joints
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6
Q

What would tender sacroiliac joints suggest?

A

Ankylosing spodylitis

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7
Q

What would a step at the lumbrosacral junction suggest?

A

Spondylolisthethis

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8
Q

How do you assess active ROM of the cervical spine?

A

Chin should touch sternoclavicular joint
Extension to 50
Lateral flexion 45
Lateral rotation 80 both sides

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9
Q

What should you do if there is restriction of ROM?

A

Cautiously assess passive ROM

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10
Q

What should you assess for ROM of the thoracolumbar spine?

A
Touch the floor?
Schober's test
Extension
Lateral flexion
Rotation
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11
Q

What is a normal distance to be away from the floor with fingers?

A

< 7cm

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12
Q

What is Schober’s test?

A

Mark 15cm of lumbar spine (10cm above and 5cm below PSIS)
Flex spine maximally
5cm minimum increase in distance

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13
Q

How do you assess extension of thoracolumbar spine?

A

Ask patient to arch back
thoracic = 25
lumbar = 35

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14
Q

What does significant pain and restriction on arching back suggest?

A

Prolapsed disc

Spondylolysis

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15
Q

How do you assess lateral flexion of the thoracolumbar spine?

A

Ask patient to flex to one side
Distance between fingers to floor should be >10cm
Equal contribution from lumbar and thoracic spine

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16
Q

How do you assess rotation of the thoracolumbar spine?

A

Seat patient
Fold arms across chest
Twist to each side
40 degree rotation all thoracic

17
Q

What should you percuss?

A

Spine from root of neck to sacrum

18
Q

What does tenderness on percussion suggest?

A

Infection
Fracture
Neoplasia

19
Q

What else should you assess?

A

Gait

20
Q

What do you do if you suspect there is a prolapsed disc?

A

Straight leg raise
Ask patient to lie flat on couch
Passively flex extended leg
Back or leg pain is positive

21
Q

What does paraesthesia or nerve root distributed pain suggest when testing for a prolapsed disc?

A

Nerve root irritation

22
Q

What does back pain suggest when testing for a prolapsed disc?

A

Central disc prolapse

23
Q

What does leg pain suggest when testing for a prolapsed disc?

A

Lateral protrusion of disc

24
Q

What is Lasegue’s sign?

A

Gradually lower leg until pain dissapears, then dorsiflex the foot. Pain suggests nerve root irritation

25
Q

What is the Bowstring test?

A

Perform a straight leg raise
If pain felt, fkex knee then press into popliteal fossa with thumb
radiating pain and paraesthesia suggests nerve root irritation

26
Q

What is the femoral stretch test?

A

Patient lying prone
Anterior thigh fixed to couch
flex each knee in turn
Pain in skin of anterior thigh is positive for disc protrusion

27
Q

What do you do if you suspect ankylosing spondylitis?

A

Chest expansion at fourth intercostal space may be reduced

28
Q

What would you do to complete the exam?

A
Full neuro exam of limbs
Abdominal exam in lower back pain
Rectal exam for cauda equina
Peripheral pulses for claudication
Shoulder exam in neck pain
Hip exam in lower back pain
29
Q

How do you finish the exam?

A

Thank the patient
Ask to redress
Present