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Back Examination (Quick Neurological Assessment of Lower Limb (Power
L4:…
Back Examination
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Lie pt. Supine
Assess back rotation c¯ arms folded across chest
Measure leg lengths: apparent length discrepancy in scoliosis
Sacroileitis Tests
Lateral compression
Stretch: adduction of hip, c¯ hip and knee flexed
Straight Leg Raise
Demonstrates lumbosacral nerve root irritation
Record angle @ pain onset
Lesague’s Sign
↑ pain c¯ foot dorsiflexion
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Look
Assess gait
Spinal curvature
Paraspinal and trapezius muscle bulk
Wall-tragus test if neck hyperflexion
Feel
Paraspinal muscle bulk and tenderness
Spine palpation: masses, steps
Spine percussion: tenderness
Move
Cervical spine movement
Lateral flexion: normally ~30O
Forward flexion: Schober’s Test
Mark 5cm below and 10cm above levels of PSIS (sacral dimples, ~S2)
Maximum flexion should lengthen line by ≥5cm
Completion
Complete neurological examination of lower limb
Especially perineal sensation
Consider a PR: exclude cauda equina compression
Lumbar Disc Herniation
Examination
Look
Gait: half-flexed, painful back
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Posture: sciatic list
Attempt to ↓ nerve root compression by leaning
to one side to open up the neural foramen
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Completion
Complete neurological examination of lower limb
Especially perineal sensation
Consider a PR: exclude cauda equina compression
Viva
Risk Factors
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Occupational
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Frequent bending, lifting, twisting
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Hx
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Pain: site, radiation, associated injury, worse / better
Neurology: weakness, numbness and paraesthesia
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Previous Rx: analgesia, physio, surgery
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Mx
Non-Surgical Mx
Conservative
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Education: keep active, how to lift / stoop
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