Spine Conditions | ASSIC Fitness and Health

Spine Conditions

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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

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