Spine clinical correlations

Question 1

femoral nerve stretch test

Answer 1

• upper lumbar root pathology at L2-L4
• pt prone. bend knee to 90 degrees, then lift thigh to elicit pain in anterior thigh.

Question 1

cervical myelopathy

• hx
• etiology
• exam
• tx

Answer 1

1. varied: loss of fine motor skills, gait disturbance, B/B dysfunction, weakness, numbness, etc
2. spinal cord compression (many causes)
3. increased reflexes in both extremities (if UMN lesion high enough). Also, positive Lhermitte’s sign, Hoffman’s sign, Romberg sign, Babinski, ankle clonus
4. surgery

Question 2

Lumbar spine tests:

(2)

Answer 2

1. straight leg raise (L5, S1)
2. femoral nerve stretch test (L2-L4)

Question 3

lumbar strain

• hx
• etiology
• exam
• tx

Answer 3

1. low back pain worse with movement and exertion, better with rest. Usually acute onset
2. excessive stretch of muscle
3. tenderness on palpation of lumbar muscles. normal neural exam
4. NSAIDs, PT, self-limiting

Question 4

disk herniation

-when is pain worse/better?

Answer 4

• pain is worse when sitting/bending forward. better standing/walking
• usually L5-S1 for lumbar

Question 4

ankylosing spondylitis

• hx
• exam
• labs
• tx

Answer 4

1. gradual onset of low back pain/stiffness. (worst in morning)
2. reduced ROM, tender over SI joints
3. increased CRP, sedimentation rate. HLA-B27 positive
4. similar to RA. NSAIDs, and TNF-alpha blockers

Question 6

straight leg raise test

Answer 6

• lumbar nerve root pathology at L5, S1
• raise pt’s leg with leg straight. pain is reproduced at 30-70 degrees

Question 7

cauda equina syndrome

• hx
• etiology
• exam
• tx

Answer 7

1. sudden onset, saddle anesthesia, bowel/urinary incontinence, leg pain
2. central disk herniation
3. loss of anal wink, saddle anesthesia, reduced leg reflexes
4. surgical emergency

Question 8

compression fracture

• what associated with?
• if pt younger than 55, suspect what?

Answer 8

• associated with osteoporosis and prolonged corticosteroid use
• suspect multiple myeloma or other malignancy

Question 9

lumbar stenosis

• hx
• exam
• etiology
• tx

Answer 9

• pain worse with extension, better with flexion. (shopping cart sign, and pt able to say how far they can walk before pain starts)
• no focal findings, normal neuro exam
• narrowing of spinal cord canal
• NSAIDs, PT, possible surgery

Question 10

Spurling’s test

Answer 10

• test for cervical root pathology
• have pt extend neck and adduct toward suspected side of pathology, while physician presses down on head
• • sign is reproduction of radicular symptoms

Question 10

Hoffman’s reflex

Answer 10

• test for UMN pathology
• tap 3rd finger–positive sign is reflex flexion of index/thumb

Question 12

cervical spine tests:

(3)

Answer 12

1. Lhermitte’s sign–pain (down spine or in arms) upon flexion of neck
2. Spurling’s test–pain on moving head towards suspected cervical injury
3. Hoffman’s reflex–tapping of 3rd finger makes index and thumb flex

Question 14

ankylosing spondylitis

-early vs late symptoms

Answer 14

early: widening of SI joints, adjacent sclerosis
late: fusion of SI joints and vertebral bodies. (bamboo spine)

Question 15

Lhermite’s sign

Answer 15

• test for cervical myelopathy
• flexion of neck produces pain down spine or extremities

Question 16

Facet joint arthropathy

• hx
• etiology
• exam
• tx

Answer 16

1. pain is relieved with back flexion, worse with back extension. (similar to lumbar stenosis)
2. facet joints rub against each other (arthritis)
3. pain provoked by extension, relieved by flexion
4. NSAIDs, PT, injections