Spine and Hip

Question 1

Anatomy of the neck, back, and hip

Answer 1

SEE DIAGRAM

Question 2

Normal ranges of motion for the joints of the neck, back and hip. Degree of range of motion

Answer 2

Neck:
 flexion; 30 degrees 
Extension; 0 degrees 
hyperextension: 30 degrees
lateral flexion; 40 degrees
rotation; 30 degrees

Back:
forward flexion; 90 degrees
hyperextension; 30 degrees
lateral flexion; 30 degrees
rotation; 30 degrees

Hip:
Flexion; 115 degrees
extension; 0 degrees
hyperextesion; 30 degrees
adduction; 30 degrees
abduction; 50 degrees
internal rotation; 30 degrees
external rotation; 50 degrees

Question 3

Thoracic kyphosis

Answer 3

normal thoracic curve of the spine to the posterior aspect

Question 4

Gibbus deformity

Answer 4

an extremely sharp kyphosis in the lumbar spine

Question 5

Lumbar lordosis

Answer 5

normal lumbar curve of the spine towards the anterior aspect

Question 6

Scoliosis

Answer 6

pathological curvature of the spine

Question 7

Kyphoscoliosis

Answer 7

exaggerated, pathological kyphosis of the spine

Question 8

Exam techniques as well as the appropriate sequence of exam used in the evaluation of the spinal column

Answer 8

After lab..

Question 9

The distraction test

Answer 9

To asses cervical spine pain and determine nerve impingement.
Place one hand under chin and the other under the occiput. Lift up gently. (+) if pain is relieved.

Question 10

The valsalva test

Answer 10

Have the patient hold their breath and bear down. If pain occurs, have patient describe location. This tests for space-occupying lesion (herniated disc or tumor) by increasing intrathecal pressure. Pain may radiate to dermatome corresponding with neurologic level of c-spine pathology.

Question 11

The Adson test

Answer 11

Determines if there is compression of the subclavian artery.
Find the patient’s radial pulse and begin to abduct, extend and externally rotate the arm. Have patient take a deep breath and turn their head toward the arm being tested. If there is compression of the subclavian artery, you will feel a marked diminution or absence of the radial pulse.

Question 12

The compression test

Answer 12

Press down on top of a patient’s head while sitting or supine. If there is an increase in pain, note distribution and dermatome. Test will reproduce pain referred to the upper extremity from the cervical spine to help locate the neurologic level of a problem.

Question 13

Straight leg raising test

Answer 13

Test to look for discogenic disease that may be compressing/affecting the sciatic nerve. Patient is supine and provider passively lifts the patient’s leg (kept straight) upwards. The foot is then dorsiflexed (toes toward shin) and if there is pain, it is likely sciatic. Make sure to distinguish sciatic pain from tight hamstrings.

Question 14

The Hoover test

Answer 14

Provider places hands under patient’s heels during the active straight leg raise test. As the patient (lying supine) tries to lift one leg upwards, the opposite heel should be pressing downward. Used to determine patient effort.

Question 15

Pelvic rock test

Answer 15

● Pt supine on exam table
● Place hands on iliac crests with thumbs on anterior superior iliac spine, palms on iliac tubercles
● Forcibly compress pelvis toward midline
○ If pt complains of pain around sacroiliac joint, may be pathology of joint itself (infection or secondary to trauma)

Question 16

Fabere Patrick test

Answer 16

detects pathology in the hip, as well as sacroiliac joint
● Pt supine on table, foot of involved side on opposite knee
○ Inguinal pain is a general indication of pathology in hip joint or surrounding muscles
● Extend the ROM by placing one hand on flexed knee joint and the other on anterior superior iliac spine of the opposite side – press down on each as if opening the binding of a book
○ If pt complains of increased pain, may be pathology of sacroiliac joint

Question 17

Trendelenburg test

Answer 17

● Stand behind pt and observe dimples overlying the posterior superior iliac spines (normally, dimples are even)
● Ask pt to stand on one leg
● Gluteus medius on standing leg should contract and elevate the pelvis on the unsupported side as soon as leg lifts off the ground
○ Elevation of pelvis on unsupported side indicates muscle is functioning properly, negative Trendelenburg
○ Pelvis remains in place/descends on unsupported side, gluteus medius is weak/nonfunctioning, positive Trendelenburg

Question 18

Thomas test

Answer 18

to detect Flexion contractures
● Pt supine with pelvis level and square to trunk
● Place your hand under pt’s lumbar spine
● Flexing pt’s hip, bring thigh up onto trunk
● As flexing pt’s hip, notice at what point his back touches your hand – this will be when flexion is isolated to hip joint
● Flex hip as far as possible (normal limits allow anterior portion of thigh to rest against abdomen, almost to chest wall)
● Repeat on other thigh
● Have pt hold one leg on chest and let other leg down until it is flat on table
○ if hip does not extend fully, pt may have a fixed flexion contracture of that hip
○ if pt rocks forward, lifting thoracic spine from table, or arches back to reform lumbar lordosis, a fixed flexion deformity is indicated

Question 19

Pelvic obliquity

Answer 19

= tilted pelvis
● Upon observation and palpation, anterior superior iliac spines are not in the same horizontal plane
● A difference in apparent leg length (measure from umbilicus to medial malleoli) may also indicate pelvic obliquity

Question 20

Deep tendon reflexes evaluated in assessing the spinal column and the spinal nerve associated with each

Answer 20

●	C5: Brachial Reflex
●	C6: Brachioradialis Reflex
●	C7: Triceps Reflex
●	L4: Patellar Reflex
●	S1: Achilles Reflex