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Spine Examination

Spine Examination. Himanshu Sharma. Axial pain Radiculopathy Myelopathy Deformity. Site Start + duration + course Exacerbating / Relieving (stenotic) Associated symptoms Weakness Coughing / P&Ns % back : leg (arm) Disability.

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Spine Examination

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  1. Spine Examination Himanshu Sharma

  2. Axial pain RadiculopathyMyelopathyDeformity

  3. Site Start + duration + course Exacerbating / Relieving (stenotic) Associated symptoms Weakness Coughing / P&Ns % back : leg (arm) Disability Bladder/bowel dysfunction Myelopathic symptoms Management so far Analgesia Physio Previous surgery History

  4. RED FLAGS OF SERIOUS SPINAL PATHOLOGY • Presentation < age 20 (10) or > 55 (65) • Non-mechanical pain, thoracic pain ? • Widespread neurology • Unwell, weight loss • Past history carcinoma, steroids, HIV • Structural deformity

  5. Tenderness superficial non-anatomical Simulation axial loading pseudo-rotation Distraction >40o SLR difference sitting v supine Regional disturbance motor eg cogwheel sensory - non anatomical Overreaction disproportionate pain response Waddell’s 5 classes At least 3 needed to be +ve

  6. Examination • Standing • Walking • Couch

  7. Standing • Look • Back • Deformity • Swellings • Birth marks • Scars • Legs • Lower limb wasting • Cavus feet / claw toes • Feel • Site of tenderness • Move • Pain worse on flexion / extension ? • Heel and tiptoe stance

  8. Ankylosing spondylitis • Chest expansion • Modified Schober test • Hip fixed flexion

  9. Neurofibromatosis • Café-au-lait • Axillary freckling • Neurofibromas • Spinal deformity

  10. Walking

  11. Couch • Abdominal (AAA) • Hips +/- knees • Pulses • SLR + tension signs • (Femoral stretch) • Sensation • Motor • Long tract signs

  12. Straight leg raise • Record angle on both sides • Record site of pain • Lasegues • reduce angle slightly + dorsiflex ankle • Bowstring test

  13. Maps • Dermatome • Myotome • Sclerotome

  14. Upper limbsSclerotome map

  15. Lower limbsSclerotome map

  16. Myotomes

  17. Long tract signs • Romberg’s • Hoffman’s sign • Lhermitte’s sign • Increased muscle tone • Brisk reflexes • Clonus • Extensor plantars • Cavus feet (long standing)

  18. Deformity

  19. History • When first noticed • Any progression • Menarche / growth potential • Any pain & its nature • Neurological symptoms • Birth marks / PMH • Family history • Siblings

  20. Examination • Trunk • shoulder height symmetry • rib hump - forward bending • waist asymmetry • hip asymmetry • side of curve and flexibility on suspension • leg length inequality • Neurological • upper and lower limbs • Subtle signs - abdo reflexes, Hoffman’s, clonus • Ligamentous laxity

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