Examination of the Adult Spine Mark Galloway, PA

Objectives Know how to obtain an appropriate and complete patient history Know how to perform physical examination as related to the spine Develop an understanding as to when to continue care vs. referring to a specialist

Chief Complaint

Determine:  Axial symptoms: neck pain, mid-back pain, low back pain  Radicular symptoms: numbness, tingling, shooting pains in UE, LE, or chest wall  Myelopathic symptoms: weakness, muscle wasting

History

When did symptoms begin Trauma vs. insidious onset Is this work related Any previous spinal injury/condition - if yes, treatment and response to treatment Any bladder or bowel dysfunction History of diabetes or TB Do symptoms cause sleep disturbance Unexplained weight loss

Imaging Studies Xrays: four views MRI CT Scan, if indicated (ie: pacemaker, heart implant)

Inspection

Observe gait/station: antalgic, trendelenburg, etc. Observe spine from behind for: asymmetry, scoliosis, scars, café au lait spots, muscle wasting/atrophy, hair tuft (spina bifida), scapular winging, kyphotic hump Observe from the side for normal curvatures: cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral kyphosis

Physical Examination

Palpate spinous processes/paravertebral muscles /SI joints for tenderness Range of motion normals: Normal Cervical Lumbar Flexion – 90 Extension Lateral rotation Lateral bending – 45 Sensory: light touch & pin prick in all dermatomal distributions, and two point discrimination if indicated

Basic Tests Cervival: Spurlings maneuver, Lhermitte's Sign Lumbar: SLR positive >60 o, Sciatic Stretch, Femoral Stretch, Schober Test, FABER - SI Babinski, Clonus

Motor

Malingering/Non-organic Back Pain Hoover Test

When to Refer

When conservative treatments fail, ie: NSAIDS, physical therapy, alternative therapy Condition continues to effect activities of daily living Prolonged radicular symptoms Any evidence of myelopathic process

Questions