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Published bySalvatore Allis
Modified over 4 years ago
Spine Examination Himanshu Sharma Himanshu Sharma
Axial pain Radiculopathy Myelopathy Deformity
History 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
RED FLAGS OF SERIOUS SPINAL PATHOLOGY Presentation 55 (65) Non-mechanical pain, thoracic pain ? Widespread neurology Unwell, weight loss Past history carcinoma, steroids, HIV Structural deformity
Waddell’s 5 classes Tenderness superficial non-anatomical Simulation axial loading pseudo-rotation Distraction >40 o SLR difference sitting v supine At least 3 needed to be +ve Regional disturbance motor eg cogwheel sensory - non anatomical Overreaction disproportionate pain response
Examination Standing Walking Couch
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
Ankylosing spondylitis Chest expansion Modified Schober test Hip fixed flexion
Neurofibromatosis Café-au-lait Axillary freckling Neurofibromas Spinal deformity
Couch Abdominal (AAA) Hips +/- knees Pulses SLR + tension signs (Femoral stretch) Sensation Motor Long tract signs
Straight leg raise Record angle on both sides Record site of pain Lasegues reduce angle slightly + dorsiflex ankle Bowstring test
Maps Dermatome Myotome Sclerotome
Upper limbs Sclerotome map
Lower limbs Sclerotome map
Long tract signs Romberg’s Hoffman’s sign Lhermitte’s sign Increased muscle tone Brisk reflexes Clonus Extensor plantars Cavus feet (long standing)
History When first noticed Any progression Menarche / growth potential Any pain & its nature Neurological symptoms Birth marks / PMH Family history Siblings
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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