Back & Neurological Examination Dr Munir Saadeddin FRCSed

Back & Neurological examination Which Patients? Back Pain (- or +Leg Pain) Back Pain (- or +Leg Pain) Back Deformity Back Deformity Neurological symptoms of lower limb Neurological symptoms of lower limb Back Injury Back Injury

Back & Neurological Examination History History Examination whilst standing out of bed Examination whilst standing out of bed Gait observation Gait observation Examination in supine position Examination in supine position Examination in prone position Examination in prone position

Patient presenting & Back & Leg Pain

Patient presenting with deformity

Back Inspection (standing)

Back Inspection (Forward Flexion)

Back Inspection in LBP

Examination of forward flexion

Examination of Lateral Flexion

Examination of Back Extension

Examination of Rotation

Standing on Heels

Standing on Tiptoes

Back Examination in Supine Position Does not include back inspection Does not include back inspection SLR and Lasague maneuver should be done SLR and Lasague maneuver should be done Test the sensation (Dermatomes) Test the sensation (Dermatomes) Test muscle power (Mainly EHL) Test muscle power (Mainly EHL) Test Reflexes Test Reflexes

SLR : Straight Leg Raising Test

SLR: 0-80 degrees

Lasague Maneuver

Sensory Testing : Dermatomes

Clinical Picture L4 Root Lesion

L4 Neurological Signs

Clinical Picture : L5 Root Lesion

L 5 Neurological Signs

S 1 Neurologic Level

Clinical Picture : S 1 Root Lesion

L4 & L5 Lesions

L5 & S1 Lesions

Investigations in Back Examination Plain X rays: AP, Lateral, Oblique, Cone View &Tomograms Plain X rays: AP, Lateral, Oblique, Cone View &Tomograms Blood Tests: CBC, ESR, Bone Biochemistry Blood Tests: CBC, ESR, Bone Biochemistry Ct scan Ct scan Myelogram, Radiculogram Myelogram, Radiculogram MRI MRI Biopsy (CT guided or Cannulated trocar under fluoroscopy) Biopsy (CT guided or Cannulated trocar under fluoroscopy)

Plain X Ray : AP & Lateral

Plain X Ray : Oblique 45 degrees

Terry Dog & Scotty Dog appearance

Scotty dog appearance

Myelogram & radiculogram

Radiculogram Left L5 Root Compression

C T Scan :(Spondylolysis)=Defect in Pars Interarticularis

C T : Intervertebral Disc Protrusion

CT Myelogram

MRI Lumbar Spine

Isotope Bone Scan (Tc99m)

Closed Vertebral Biopsy

Closed vertebral biopsy

Closed Vertebral biopsy

Muscle Power Evaluation Certain muscles at lower or upper limbs Certain muscles at lower or upper limbs We test Muscle Power NOT range of joint movements! We test Muscle Power NOT range of joint movements! We give result by We give result by 0 - 5

Hip Flexion : Iliopsoas Muscle

Iliopsoas Muscle power Test

Hip Adductor muscles( Obturator N)

Hip Adductors Test

Quadriceps Muscle (Femoral Nerve)

Quadriceps Muscle Test

Tibialis Anterior Test

Psychological Aspects in Back Exam