Examination of Spine

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Examination of Spine

Examination of Spine

Mr. George Ampat

Consultant Orthopaedic Surgeon

Southport and Ormskirk Hospitals NHS Trust


HISTORY

• Pain

– Location

– % Limb % Leg.

– Quality

– Chronicity

– Night pain / Non mechanical

– Aggravating and relieving factors.

– Vascular Vs Neurologic.


HISTORY

• Associated neurological symptoms

– Gait

– Sensory loss / dysesthesia

– Loss of motor activity

– Bladder bowel disturbance


Examination

• Look - Feel – Move


Normal

Flexion

Extension


Painful

Flexion

Extensio

n


Normal

Painful

Degenerate disc

Or Black disc

Causing Segmental

instability


DISC PROLAPSE

DISC DEGENERATION


Straight Leg Raising Test (SLRT)


Femoral Stretch Test (FST)


Muscle Grading

• 5 – Normal (Full ROM)

• 4 - With some resistance (Full ROM)

• 3 – Against gravity (Full ROM)

• 2 – With Gravity eliminated (Full ROM)

• 1 – Flicker with no joint motion


DTR grading

• 0 – Absent

• 1 – Sluggish

• 2 – Normal

• 3 – Hypertonic

• 4 – Clonus


Upper Motor Neurone sign

• Clonus, Increased Deep Tendon

Reflexes are signs of Upper Motor

Neurone lesion.


DTR levels

• 1,2 S – Ankle

• 3,4 L – Knee

• 5,6 C – Biceps

• 7,8 C – Triceps

1, 2 Buckle my Shoe

3, 4 Kick the door

5, 6 Pick up the sticks

7, 8 Lay them straight


Radiculopathy – Affection of nerve root

Arm pain and Neurological deficit in a

single limb with lower motor neurone

signs.

Myelopathy – Affection of spinal cord

B/L stiffness of fingers, pins and needles,

loss of balance with upper motor neurone

signs.


Brain & Spinal Cord

Upper Motor Neurone

Peripheral nerves

Lower Motor Neurone


Radiculopathy


Radiculopathy


Radiculopathy


Myelopathy

Hoffman’s

Inverted radial

Grip and release

Babinski

Finger escape


72 Female with stiffness 1 year and LOB 3/52


72 Female with stiffness both hands with P&N 1 year


72 Female with stiffness both hands with P&N 1 year


72 Female with stiffness both hands with P&N 1 year


72 Female with stiffness both hands with P&N 1 year


72 Female with stiffness both hands with P&N 1 year


Mrs GB


Red Flags

• Bowel/bladder dysfunction

• Pain not relieved in the supine position /

awakened from sleep. Pain worse at night

• First onset of back pain in elderly.

• Unexplained weight loss

• History of cancer

• Recent trauma / Mild trauma with a history

of osteoporosis

• Fever

• IV drug use


Reminder


Thank

Yo u

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