textbook

PHYSICAL EXAMINATION OF THE SPINE

PRESENTED BY:Ita Puspita Dewi (C11106105)Siti Zaharah Bt. Gusti Ruslan

(C11106246)Muh. Farid Huzein (C11107140)

Hasmia (C11107208) Aimi Haniza Zainal (C11107352)

Andi Irhamnia Sakinah (C11108263)

Yunialthy Dwia Pertiwi (C11108303)

ADVISORS:dr. Muhammad Petrus Johan

dr. Erick Gamaliel Ambadr. Evan

Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin University

Makassar2012

SPINE

INTRODUCTIONGeneral Principles

The physical examination of the spine should follow the usual pattern of orthopedics examinations.a. Inspection of relevant body partsb. Palpation of relevant structuresc. Tests for range of motiond. Specific/more extensive neurologic

and vascular examinationProvocative Maneuvers

1. AAOS Comprehensive Orthopaedics Review, Section 7 Spine, Chapter 63 Physical Examination of The Spine by Alan S. Hilibrand, MD

CERVICAL SPINE

InspectionAny deformity is noted. Wry

neck, due to muscle spasm, may suggest a disc lesion, an inflammatory disorder or cervical spine injury; but it also occurs with intracranial lesions and disorder of the eyes or semicircular canal. Neck stiffness is usually fairly obvious.

1..Apley’s

1..Apley’s

PalpationThe front of the neck is most easily

palpated with the patient seated and the examiner standing behind him or her. The best way to feel the back of the neck is with the patient lying prone and resting his/her head over a pillow; this way the patient can relax and the bony structures are more easily palpated. Feel for tender areas or lumps and note if the paravertebral muscles in spasm

Palpation

1.. Apley’s

Range of MotionForward flexion, extension,

lateral flexion and rotation are tested, and the sholder movement. Range of motion normally diminishes with age, but even in the older patient movement should be smooth and pain free.

1.. Apley’s

Range of Motion

1. Apley’s

Neurovascular DistalNeurological examination of the

upper limb is mandatory in all cases. Muscle power, reflexes and sensation should be carefully tested; even small degrees of abnormlaity may be significant.

The pulses of brachial, radial, and ulnar should be palpated. Absent/ diminished of the pulses lead to vascular injury or compromise.

1. Apley’s

1. Netter’s

Neurovascular Distal

PROVOCATIVE TEST

The Spurling Maneuver

Very specific for nerve root compression in the lateral recess and/or foraminal zone. Applying an axial load to the

neck while it is rotated toward the side of the pathology and placed into extension.

Positive when holding the patient in this position for 30 seconds recreates radicular symptoms, which may consist of pain, numbness, tingling, or paresthesias into the appropriate dermatome. These findings should occur ipsilateral to the lesion.1. AAOS Comprehensive Orthopaedics Review, Section 7 Spine, Chapter 63 Physical Examination of The Spine by Alan S. Hilibrand, MD

Lhermitte SignShock-like sensations radiate down the spinal axis into the arms and/or legs when the neck of a patient with cervical spinal cord compression is brought into extreme flexion or extension, causing stretch and direct compression of the spinal cord.In patients with acute radiculopathy, this

maneuver may reproduce the radiculopathy

Specific (not sensitive) for myelopathyNeither specific nor sensitive for identifying

cervical radiculopathy1. AAOS Comprehensive Orthopaedics Review, Section 7 Spine, Chapter 63 Physical Examination of The Spine by Alan S. Hilibrand, MD

Another Special TestExam Technique Clinical

Application

Distraction Upward distracting force

Relief of symptoms indicates foraminal compression of nerve root

Kernig Supine: flex neck Pain in or radiating to legs indicates meningeal irritation/infection

Brudzinski Supine: flex neck, hip flex

Pain reduction with knee flexion indicates meningeal irritation