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Spine Conditions

Categories
  • Education
  • Joint/Tendon
Tags
  • back injury
Spine Examination

Introduction

Presentation:

  • Backache due to musculoskeletal related problems is a common problem to be encountered.
  • There are various causes and contributing factors.
  • Some of the causes of backache range from acute muscle strain to disc herniation, nerve compression, spine infections and tumours.
  • Correct diagnosis and appropriate management is important.

Examples of spine conditions

Acute disc herniation
Acute disc herniation
Spinal stenosis
Spinal stenosis
Spinal stenosis with an acute disc herniation
Spinal stenosis with an acute disc herniation

Pathology at L5/S1

Pars Interarticularis, Spondylolysis and Spondylolisthesis
Ankylosing spondylitis
Scoliosis
Scoliosis

Examination

  • Examination includes the exclusion of non-musculoskeletal causes.
  • Examination includes an assessment of any sensory or motor deficit.
  • Assessment of structurally obvious abnormalities.
  • Reflexes are tested.
  • Bowel and bladder assessment are done.
  • Other special clinical testing where appropriate.

Common Examination Testing

Description: inspection

  • Assess bilateral upper and lower limbs
  • Look for muscle wasting
Normal spine anatomy
Anterior surface anatomy
Knee Examination

Examination

C-spine ROM

C-spine ROM: Lateral flexion
Lateral flexion
C-spine ROM: Rotation
Rotation
C-spine ROM: Flexion & extension
Flexion & extension

T-spine

Inspect Palpate
Inspect Palpate

L-spine ROM

L-spine ROM: Flexion
Flexion
L-spine ROM: Extension
Extension
L-spine ROM: Lateral flexion
Lateral flexion
L-spine ROM: Rotation
Rotation

Sensory cutaneous nerves

Sensory cutaneous nerves
Sensory cutaneous nerves

Sensation Examination

Dermatome assessment

Dermatome assessment
Dermatome assessment
Dermatome assessment

Motor Examination

Muscle power grading

Grade Description
0 No muscle contraction
1 Trace contraction by palpation while the muscle is being contracted
2 Muscle movement but without gravity
3 Muscle movement against gravity but not against resistance
4 Muscle movement against some resistance
5 Muscle against resistance, normal muscle strength
Muscle groups are tested for power and graded accordingly

Examine Upper limb power - C5

Examine Upper limb power
Resisted shoulder abduction
Resisted arm flexion
Resisted arm flexion

Examine Upper limb power - C6

Resisted wrist extension
Resisted wrist extension

Examine Upper limb power - C7

Resisted elbow extension
Resisted elbow extension

Examine Upper limb power - C8

Resisted finger flexion
Resisted finger flexion

Examine Upper limb power - T1

Resisted finger flexion
Resisted finger abduction

Examine Lower limb power - L 1/2

Resisted hip flexion (hip flexor muscles)
Resisted hip flexion (hip flexor muscles)

Examine Lower limb power - L3

Resisted knee extension
Resisted knee extension

Examine Lower limb power - L4

Resisted ankle dorsiflexion
Resisted ankle dorsiflexion

Examine Lower limb power - L5

Resisted ankle dorsiflexion
Resisted big toe extension (Extensor Hallucis Longus muscle)

Examine Lower limb power - S1

Resisted foot plantarflexion
Resisted foot plantarflexion

Examination of Reflexes

Upper limb reflexes

Lower limb reflexes:
  • Patellar
  • Ankle
Patellar reflex test
Patellar reflex test

Common Investigations in diagnostic workup

  • Radiological investigation may include X-rays, CT and/or MRI scans.
  • Blood investigations where clinically relevant.

Management

  • Correct diagnosis for appropriate management.
  • Treat the specific cause and contributing factors.
  • Non surgical management include analgesia and rehabilitation.
  • Surgery management in selected cases for the specific underlying cause.

Surgical options for disc related problems

Disc Surgery

Surgical options in selected spine conditions

Spine Fusion
Spine fusion:

Decompression and spine fusion with pedicle ad rod fixation

Download ASSIC Performance Fingerprint and Strength & Conditioning apps for guideline on back rehabilitation under your professional supervision

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