The Spine

Question 1

the spine

Answer 1

Cervical (C1-C7)
Thoracic (T1-T12)
Lumbar (L1-L5)
Sacrum
Coccyx
Total of 24 vertebrae

Central supporting structure of trunk and back
Concave curvature to cervical and lumbar
Convex curvature to thoracic and sacrococcygeal

Question 2

vertebrae

Answer 2

• Vertebral body supports weight bearing (anterior)
• Spinous processes are what you palpate: posterior
• Vertebral foramen encloses spinal cord and intervertebral foramen channel for spinal nerve roots
• Cervical spine: transverse foramen for vertebral artery

Question 3

cartilaginous joint

Answer 3

• Bony surfaces separated by cartilaginous discs.
• Center of each disc nucleus pulposus (shock absorber)
• Example: vertebral bodies of spine

Question 4

excessive curvature

Answer 4

kyphosis, kyphoscoliosis, compression fractures (osteoporosis)

Question 5

loss of curvature

Answer 5

paraspinous muscle spasm, DDD

Question 6

spine inspection

Answer 6

• From side: inspect for normal/abnormal lordosis and kyphosis
• From back: inspect alignment of shoulders and waist (asymmetry may indicate scoliosis)
• Inspect skin for dimpling, masses or lesions
• Inspect while patient bends forward, look for rib hump (scoliosis affecting the thoracic spine)

Question 7

scoliosis

Answer 7

• corkscrew-type curvature of spine

- can cause restriction of lung development in children if not corrected

Question 8

spina bifida

Answer 8

Folic acid deficiency

Open neural tube defect

Question 9

inspection of cervical spine

Answer 9

posture, spinal curvatures (side), alignment (posterior), skin markings or masses

Question 10

palpation of cervical spine

Answer 10

spinous processes, facet joints C2-C7; paravertebral muscles

Question 11

ROM of the neck

Answer 11

Flexion
Extension
Rotation: look over shoulder
Lateral Bending: ear to shoulder

Be sure to stabilize shoulders to accurately assess the cervical spine motion

Question 12

inspection of thoracic spine

Answer 12

Inspection from the side and back

Inspection with the patient bending forward, evaluate for kyphoscoliosis

Question 13

palpation of thoracic spine

Answer 13

Palpation of the spinous processes and paravertebral muscles

Question 14

inspection of lumbar spine

Answer 14

Inspect from side and back

Question 15

palpation of lumbar spine

Answer 15

• Palpate spinous processes and paraspinal muscles
• Palpate sacroiliac joints
• Palpate sciatic nerve/notch and piriformis muscle

Question 16

straight leg raise

Answer 16

• test for sciatic nerve impingement
• With the patient sitting or supine, passively raise the affected leg
• If pain and radiculopathy, positive test
• Indicates sciatic nerve impingement

Question 17

piriformis syndrome

Answer 17

-common cause of buttock and posterior leg pain. Typically, the piriformis muscle becomes taught, tender, and contracted
-deep aching sensation in the mid-gluteal region that is sometimes associated with pain radiating down the posterior leg. The tight piriformis muscle may cause a nerve and vessel entrapment syndrome because of its close proximity to the sciatic nerve and surrounding vessels.
The piriformis muscle exits the pelvis through the greater sciatic foramen and inserts on the greater trochanter of the femur. The obturator internus exits the pelvis by passing through the lesser sciatic foramen. It also inserts on the greater trochanter of the femur. Both muscles assist in the same movement of the thigh (external rotation and abduction).
The primary symptom of piriformis syndrome is buttock pain, with or without posterior thigh pain, that is aggravated by sitting or activity. Associated low back pain suggests involvement of other structures, such as facet joints or iliopsoas muscles. In an isolated piriformis syndrome, the major findings include buttock tenderness from the sacrum to the greater trochanter and reproduction of buttock pain on prolonged hip flexion, adduction, and internal rotation.
Pain is often referred down the posterior portion of the leg following the distribution of the tibial and peroneal branches of the sciatic nerve. These branches become inflamed as they pass over, under, or through the tight piriformis muscle. Pain is thought to be caused by myotendinous breakdown of the piriformis muscle, as well as by focal demyelination of the affected branches of the sciatic nerve. The piriformis muscle is usually tight and contracted, with focal trigger point tenderness on palpation. Piriformis syndrome is frequently associated with sacroiliac dysfunction and leg length discrepancies.
Piriformis syndrome may constitute up to 6-8% of low back pain conditions associated with sciatica. However, patients typically experience symptoms in all 5 toes (multiple dermatomes) rather than in lateral toes (S-1 radiculopathy) or medial toes (L-5 radiculopathy), as is commonly seen in patients with herniated lumbar discs. The straight-leg raise (SLR) test is generally negative, and pain is the predominant symptom; numbness or weakness is rare.

Question 18

examining lumbar spine

Answer 18

• ROM of the lumbar spine
• Stabilize patient’s pelvis while assessing:
• -Flexion
• -Extension
• -Rotation
• -Lateral bending

Question 19

most commonly affected nerves

Answer 19

C6-8, L4-S1

Question 20

dermatomes (spinal nerves)

Answer 20

• Dermatome map
• C6: thumb; C8: ring/pinky fingers
• L4: knee; L5: great toe web space; S1: lateral malleolus

Question 21

myotomes (peripheral innervation of muscles)

Answer 21

C6-8: Grip strength, wrist flexion/extension, triceps
L3-4: knee extension
L4-5: ankle dorsiflexion, big toe extension (extensor hallucus longus); walking on heels
L5-S1: plantar flexion; walking on toes

Question 22

deep tendon reflexes (spinal reflexes)

Answer 22

• Biceps (C5-6), Brachioradialis (C5-6), Triceps (C7)

- Patellar (L4), Achilles (S1)

Question 23

neck pain/injury

Answer 23

• Inspect & palpate neck/C-spine
• Active/passive ROM C-spine
• Dermatomes C6-8
• DTR: biceps, triceps
• AROM/strength in biceps, wrists, triceps, fingers (myotomes)

Question 24

low back pain/injury

Answer 24

• Inspect & palpate lumbosacral spine, SI joints, hips
• Active/passive ROM lumbar spine
• Dermatomes L2-S1 DTR: patella, Achilles
• Gait
• AROM/strength in LE/toes (myotomes)
• SLR
• Bladder & bowel function
• (Anal sphincter tone, anal wink/reflex)