3.2 Spinal Exam
Inspect
pt standing
cerv lordosis, thor kyphosis, lumbar lordosis
Muscle bulk, spasm, wasting
pelvic tilt
midline dimples
hairy tuft -> spina bifida occulta
palpate
spinous process, sacroiliac joints
paraspinal muscles
while pt standing/lying
move
cervical spine
active mvmt
flexion
extension (lost 1st)
lat flexion
rotation
thoracic/lumbar spine
active
flexion
extension
lat flexion
lateral rotation w pelvis fixed
straight leg raising
neurological exam
flexion - schobers test
lat flexion: lost early in inflamm disease
ipsi pain = facet joint
contra pain = ligamentous
sacroiliac joint
pathology : low back pain -> buttock/thigh
direct pressure of SIJs, both thumbs while pt leans forward on exam couch
pressure over sacrum w pt lying prone
measurement:
modified schobers test
mark line btw dimples of Venus, take point 10cm above & 5cm below
pt flexes forward, measure distance btw
7cm
neurological exam of lower limb
inspect
muscle bulk, fasciculations
mvmt
tone & power
reflexes
knee jerk
ankle jerk
plantar response
straight leg raise test
pt lying supine
elevate leg to 30-70 degrees -> pain radiating down leg -> below the knee
pain
<30 = inappropriate
60-70 = hamstring tension
30-60 degrees- maybe radiculopathy
pain = "hard to describe"
femoral stretch test
pt standing on 1 leg, hold table
flex knee, hyperextend hip
pain on ant thigh = positive
pt shouldn't be able to sit @ 90 degrees w knees extended
for exam, fix pelvis by holding/getting pt to sit off edge of bed
ask: am i reproducing the same symptoms this way
waddell's signs
excessive tenderness, on light pressure
inconsistent/variable pain site
distraction
complete inability to flex spine
complete inability to leg raise
indicates non-organic/psychological component to lower back pain
palpate
dorsalis paedis pulse on foot