Thoracolumbar Spine Exam

Question 1

thoracolumbar spine requires inspextion, palpation, strength and sensory testing in the __ ___ ___ ___ _positions

Answer 1

sitting, standing, lying on side, and walking positions

Question 2

STANDING

Inspection

Answer 2

LKS. SSMMRLT

1. comment on lordosis, kyphosis and scoliosis; to check for scoliosis, they should bend over to see if shoulder plades are even. If uneven, might be scoliosis
2. scars
3. symmetry and swelling
4. masses
5. muscle spasm
6. redness
7. level of the SI join
8. Trendelenberg sign– more of a walking test. see walking section.

Question 3

STANDING

Palpation (what’re you palpating for)?

Answer 3

Palpating for tenderness and tone (PSIS)

erector spinae muscles– iliocostalis, longissimus, spinalis

spinous processes

interspinous ligaments

sacroiliac joints

Sciatic nerve exits from the piriformis muscle

Question 4

erector spinae muscles

Answer 4

erector spinae muscles– iliocostalis, longissimus, spinalis

Question 6

step after standing palpation

Answer 6

standing percussion– tap down the back with the ulnar aspect of fist

Question 7

STANDING Range of Motion

Answer 7

should be ACTIVE. FLER

1. flexion– knees dhoulf remain straight–measure distance between finger tips and the floor. Note the smoothness and symmetry of movement– can detect scoliosis in this movement. As flexion proceeds, the lumbar concavity should flatten out. A persisting lumbar lordsis is suspicious for muscle spasms of ankylosing spondylitis.

2/ extension (place hand on the posterior superior iliac spine to give your patient some support

3. lateral flexion– fingertips should easily reach the level of the knees
4. rotation. make sure that the knees are straight, feet stay together, and hips remain facing forward. Can also be checked with patient sitting, as this prevents unwanted movements of the hips or pelvis.

Question 8

when standing, when a person flexes in active ROM, what might indicate ankylosing spondylitis?

Answer 8

As flexion proceeds, the lumbar concavity should flatten out. A persisting lumbar lordsis is suspicious for muscle spasms of ankylosing spondylitis.

Question 9

WALKING Inspection- what to comment on?

Answer 9

PBSwMSmo

1. observe gait and comment on posture, balance, swinging of arms, movement of legs, smoothness of turns
   - look for antalgic, trendelenburg, ataxic.

Question 10

what to do after walking inspection

Answer 10

walking strength and nerve testing:

L3 and L4: deep knee squat bend

L5: Heel walking

L5-S1: hip extensino (gluteous maximus)

S1: toe walking

Question 11

during the walking/strength test, outline which nerves are responsible for which move:

L3 and L4: __

L5: __ walking

L5-S1: __ __ (gluteous maximus)

S1: __ walking

Answer 11

L3 and L4: deep knee squat bend

L5: Heel walking

L5-S1: hip extensino (gluteous maximus)

S1: toe walking

Question 12

after standing and walking inspection/exam, the next is sitting. what to do during inspection of sitting test?

Answer 12

• take not of the ability to get on and off the table.

Question 13

outline the exam for sitting component of thoracolumbar spine exam

Answer 13

1. ask pt to sit on table. note how they get onto the table
2. light touch sensation:

• L1- groin
• L2- upper inside thigh
• L3- lower inside thigh
• L4- inside of calf and great toe
• L5- outisde of calf/dorsum of foot
• S1- outer aspect of foot.

3. Palpation– test the sensation of the nerve roots

• L4- medial malleolus
• L5- first dorsal web space
• S1- little toe.

4. Strength Testing;

• L1-L2; hip flexors
• L2-L3: hip adductors
• L4-L5: hip abductors
• L5-S1: hip extension?

5. Reflexes

• L3-L4: patellar reflex
• S1: achilles reflex.

*do not forget to demonstrate how you would elicit reflexes in someone who was not able to relax.

Question 14

sitting light touch sensation aspect of exam

Answer 14

L1- groin

L2- upper inside thigh

L3- lower inside thigh

L4- inside of calf and great toe

L5- outisde of calf/dorsum of foot

S1- outer aspect of foot.

Question 15

sitting strength testing part of exam

Answer 15

L1-L2: hip flexors

L2-L3: hip adductors

L4-L5: hip abductors

L5-S1: hip extendors

Question 16

palpation test when sitting

Answer 16

L4: medial malleolus

L5: dorsal web of big toe

S`1: little toe

Question 17

sitting reflexes

Answer 17

L3-L4 patellar reflex

S1: achilles heel

Question 18

Outline the exam when lying on side

Answer 18

palpation

identiy the sciatic nerve exit under the piriformis

• the trochanteric and ischial bursa
• SAY YOU’LL DO THE DRE AND ASSESS FOR SADDLE PARESTHESIA OR ANAL WINK

Question 19

test to assess for ankylosing spondylitis

Answer 19

modified shober’s test

. if the distance between the two points is less than 20 cm when bent over, you should suspect that the flexion of the lower back is limited.

Question 20

two tests to assess disc protrusion impinging the nerve roots

Answer 20

1. straight leg raise.

– passively flex the hip while keeping the knee straight on the side where the pain is felt. stop when the patient reports feeling pain. lower the leg until pain resolves. dorsiflex the foot.– pain felt shooting down the affected leg in thiese positions is abnormal

2. cross straight leg raise test

– passively flex the hip while keeping the knees straight on the opposite side of where pain is felt. Pain shooting down the affected leg is abnormal.

Question 21

special tests to assess the integrity of the ASIS

Answer 21

sacroiliac stress test

• assesses the integrity of the asis
• downward distracting force over the ASIS bilaterally
• compression of the pelvis at the level of the SI joints

Question 22

overall 4 special test for thoracolumbar spine exam

Answer 22

1. modified schobers
2. straight leg raise test
3. cross leg raise test
4. ASIS integrity compression test. Sacroiliac stress test.