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MSK > Spine Exam > Flashcards

Spine Exam Flashcards

1
Q

What does café-au-lait spots or axillary freckling suggest

A

Neurofibromatosis

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1
Q

Upon inspection on spine exam, looking for

A

Cervical / Lumbar Lordosis,
Kyphosis
Skin - café-au-lait spots or axillary freckling
a sacral dimple, naevus or hairy patch
Scarring
Asymmetry - head and neck posture

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2
Q

What does a sacral dimple, naevus or hairy patch suggest

A

Spina bifida occulta

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3
Q

Palpation of the spine

A

All spinous processes, and para spinal muscles.
Palpate for tenderness over the sacroiliac joints
Examine the supraclavicular fossae for any masses

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4
Q

What may tenderness over sacroiliac joints suggest

A

ankylosing spondylitis

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5
Q

What to move in spine

A

Move - Flexion, extension, lateral rotation and lateral flexion of cervical and lumbar!

Rotation - seated and asked to twist

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6
Q

What is schobers test

A

Mark a 15cm length of the lumbar spine with the patient in the erect position), measuring 10 cm above and 5 cm below the posterior superior iliac spines (Dimples of Venus). Instruct the patient to flex his or her spine maximally. Re-measure the distance between the marks. Normal flexion increases the distance by at least 5 cm.

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7
Q

Pain upon extension?

A

Pain and restricted extension are particularly common in prolapsed intervertebral disc and spondylolysis.

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8
Q

What are we assessing with rotation of the spine and why must pt be sat

A

The patient should be seated (this prevents pelvic rotation), asked to fold their arms across their chest then asked and to twist round to each side. The normal range of rotation is 40° and is almost entirely thoracic. The lumbar contribution is <5°.

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9
Q

Percussion of spine?

A

Ask the patient to bend forward and lightly percuss the spine from the root of the neck to the sacrum. Significant percussion tenderness is a feature of infection, fractures and neoplasia.

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10
Q

Assess patients gait. Abnormal gaits include:

A

antalgic gait, presence of a foot drop, trendelenburg gait in particular.

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10
Q

Innervation of Shoulder abduction and flexion

A

C5

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11
Q

Innervation of Elbow flexion

A

C5/6

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12
Q

Innervation of Elbow extension

A

C7/8

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13
Q

Innervation of Wrist flexion and extention

A

C6/7

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14
Q

Innervation of Finger flexion / extension

A

C7/8

15
Q

Innervation of Finger abduct / adduct

A

T1

16
Q

Innervation of hip flexion

A

L1/2

17
Q

Innervation of hip extension

A

L4/5

18
Q

Innervation of Knee flexion

A

L5/S1

19
Q

Innervation of Knee extension

A

L3/4

20
Q

Innervation of ankle dorsiflexion

A

L4/5

21
Q

Innervation of ankle plantar flexion

A

S1

22
Q

Innervation of Gt toe dorsiflexion

A

L5

23
Q

What to do to complete examination

A
  • Neurovascular examination of the upper and lower limbs.
  • Examination of the hip and shoulder joints.
  • Further imaging if indicated (e.g. X-ray/MRI).
24
Q

If pt presents with Lower back pain, what other examinations

A
  • In a patient presenting with lower back pain, perform an abdominal examination to identify any masses, and consider a rectal examination (omit in the OSCE) to check for loss of anal tone and perianal sensation (cauda equina syndrome).
25
Q

Why is it important to also assess peripheral pulses?

A

vascular claudication in the upper and lower limbs may mimic the symptoms of radiculopathy or canal stenosis.

26
Q

Difference between lumbar stenosis and vascular claudication

A

Lumbar stenosis is usually worse walking downhill and does not settle on standing still.

Vascular claudication is worse walking uphill and settles on standing still.

27
Q

Special tests for suspected prolapsed iv disc

A

Straight leg raise
Bowstring test
Femoral stretch test

28
Q

Special tests for suspected ankylosing spondylitis

A

Schobers test and assess chest expansion at 4th IC space (3-5cm) which is reduced in AS

29
Q

What is the bowstring test

A

Perform a straight leg raise. If the patient experiences pain, flex the knee slightly then apply firm pressure with the thumb in the popliteal fossa to stretch the tibial nerve. Radiating pain and paraesthesiae suggest nerve root irritation.

30
Q

What is the femoral stretch test

A

With the patient prone and the anterior thigh fixed to the couch, flex each knee in turn. This causes pain in the skin overlying the anterior compartment of the thigh by stretching the femoral nerve roots in L2-L4. The pain produced is normally aggravated by extension of the hip.

31
Q

Common spinal conditions

A
  • Osteoarthritis of Spine and Neck
  • Spinal Disc Disease
  • Nerve Root Impingement
  • Sciatica
  • Femoral nerve injury
32
Q
A

MSK (12 decks)

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