Week 2: Physical examination for spinal conditions

Question 1

What are the aims of physical examination?

Answer 1

1. confirm diagnosis
2. understand how postures, mvmt and func. activities influence symptoms
3. determine most appropriate Rx
4. Identify outcomes for reassessment

Question 2

What is the purpose of AM’s in physical exam?

Answer 2

• reproduce and start to understand Pt.’s pain
• relationship of forces to symptoms
• directional patterns
• protective m.
• measure ROM/pain limitation

Question 3

What are the ROM norms. in the lumbar spine?

Answer 3

• Flex.: 52deg.
• Ext.: 16deg.
• S/flex.: 18deg
• Rot.: 5deg.

–> lots of indv. variation

Question 4

What are ROM norms. for cervical spine?

Answer 4

• Felx.: 45-50deg. (C0-C1 - 14deg.)
• Ext.: 85deg. (C0-C2 - 20deg.)
• S/flex.: 20-45deg.

Question 5

What are ROM norms. for thoracic spine?

Answer 5

• Flex.: 20-45deg.
• Ext.: 25-45deg.
• S/flex.: 20-45*

Question 6

What are the different types of stressful tests (further exploration)?

Answer 6

• OP
• Combine mvmts
• Sustain mvmts
• Repeated mvmts

Question 7

When would you use a stressful procedure?

Answer 7

When AM’s alone do not reproduce Pt.’s symptoms

Question 8

Why reproduce substantial extent of symptoms in non-irritable Pt.’s?

Answer 8

• Provide better re-assessment finding
• Further info. on relationship between forces and symptoms
• Information about possible Rx progressions

Question 9

What are the 2 parts of combined mvmts?

Answer 9

• Primary mvmt: AM which most closely reproduces Pt.’s symptoms
• Secondary mvmt: any remaining mvmts which reproduce Pt.’s symptoms

Question 10

What are the indications for a neuro. exam?

Answer 10

• Pain in deratomal distribution
• Pain radiating past the buttock
• Altered sensation in UL or LL
• Pain in the extremities that may be related to a L/sp or C/sp condition

Question 11

What is a dermatome?

Answer 11

Area of skin supplied by a single spinal segment

Question 12

What is a myotome?

Answer 12

Mm. supplied by a single spinal segment

Question 13

What are the implications of a +ve neuro for Ax and Rx?

Answer 13

• Can’t do a PAIVM in Ax

* Rx more focused on increasing size of IV foramen

Question 14

How would you test for CNS conditions?

Answer 14

• clonus

* Babinski reflex

Question 15

What is the purpose of palpation?

Answer 15

To provide info. about tissue status and confirm diagnosis

Question 16

What are C/I’s for doing a PAIVM?

Answer 16

• malignancy
• cauda equina syndrome
• fracture
• active inflammation
• infective bone disease
• unstable neuro finding

Question 17

What are precautions for doing a PAIVM?

Answer 17

• chronic neurological signs
• osteoporosis
• spondylolisthesis (at level)
• radicular pain (-ve neuro)

Question 18

What is the purpse of n. provocation tests and how do you do them?

Answer 18

• To examine the response to mvmt of n. and surrounding CT
• straight leg raise
• prone knee bend
• passive neck flex.
• upper limb tension test

Question 19

What is the purpose of SIJ tests and when would you do them?

Answer 19

• identify Pt.’s who are more likely to have pain originating from the SIJ
• when Hx suggests likelihood of SIJ pain