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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
Back Pain Mr. Ash Mukherjee Specialist Registrar Emergency Medicine.
Back Pain Examination, assessment, red flags, Good Back Guide. Jon Dixon, Bradford VTS.
Musculoskeletal HDR Mark Brooke Samar Shefta Why Is MSK So Important? 1 in 5 patients consulting their GP is for a MSK condition MSK conditions are often.
Back pain – a comprehensive guide Lawrence Pike James Street Family Practice.
Lower Extremity: Osteopathic Approach to Patients with Postural Imbalance: Short Leg Syndrome Katrina C. Rakowsky, D.O. CORE OMM Curriculum 2005 – 2006.
Preventing Back Injuries. Reduce Your Risk of Back Injuries Most Americans experience back pain at some point in their lives. Back injuries account for.
Copyright 2002 CareGroup Occupational Health Network Provocative Testing & Diagnostics of Upper & Lower Extremity Conditions Tom Winters, MD, FACOEM,
Sports Med 2. History Most important thing to do is rule out a spinal cord injury Did you land on top of, or hit someone with your head Did you lose.
Common orthopaedic symptoms. Commonly body parts encountered Low back Neck Knee Elbow Shoulder.
RB: A Case of Tetraparesis Block Y. Tagomata. Talan. Tayag. Tolibas. Toledo. Uy. Wi. Yu. Zaldivar. Zamora.
Chapter 19: The Ankle and Lower Leg © 2011 McGraw-Hill Higher Education. All rights reserved.
Chapter 19: The Ankle and Lower Leg.
First Aid. Emergency Procedures Emergency care is defined as an unforeseen combination of circumstances and the resulting state that call for immediate.
© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 20: The Knee and Related Structures.
The Program Warm-up Dynamic stretching Plyometrics/agility Strength Static stretching.
Basic Injury Evaluation: HOPS Sara Thomas, MEd, ATC Clinical Lead- Dr. Cooper/DME Coordinator Fort Wayne Orthopedics.
1 Disclaimer All stretches should be performed in the manner described. Hold each position at the point of comfortable stretch for 10 seconds. Employees.
District 3 Presents…. Mn/STEP Warm-Up Keep your back straight. Relax your arms at your sides. Begin walking in place. Swing arms back in forth in opposition.
© 2010 McGraw-Hill Higher Education. All rights reserved. Chapter 15: The Ankle and Lower Leg.
Chapter 18: The Foot © 2011 McGraw-Hill Higher Education. All rights reserved.
UNIVERSITY of N ORTHERN C OLORADO. To move forward press enter or the down arrow key To view the previous slide press backspace or the up arrow key.
Neck & Back Care Michelle Kwong B.HSci(Phty), MSPA, Cert. Clinical Pilates Principal Physiotherapist Practice Director
Occupational Therapy (Oncology & Palliative Care), COTSSO, 10 April 2013 Bone Metastases and Pathological Fractures Author: Nimisha Panchmatia Version:
Back Problems Screening & Prevention Tips. Backache Each year as many as 25 million Americans seek a doctors care for backache Good fitness can help the.
Applying a Hare Traction Splint (3 of 3) Connect loops of ankle hitch to end of splint as your partner continues traction. Carefully tighten ratchet to.
© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 13: Off-the-Field Injury Evaluation Part I.
To improve ones speed an athlete must obtain proper technique and form, while balancing workouts with proper rest. Warm-up Frontside mechanics Backside.
Spine Rehab Sports Med. Most athletes with back pain have some fluctuation of their symptoms in response to certain postures and activities General rule.
Lower Limb Problems Orthopaedic Medicine Scope Painful hips. Painful thighs. Pain in the knee. Shin problems. Ankle problems. Foot problems.
The Core Essentials GOLF Program Core Essentials specializes in personal training for ALL populations including: Post-Rehabilitation patients.Post-Rehabilitation.
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