1. Back & Neurological Examination Dr Munir Saadeddin FRCSed

2. Back & Neurological examination Which Patients? Back Pain (- or +Leg Pain) Back Pain (- or +Leg Pain) Back Deformity Back Deformity Neurological symptoms of lower limb Neurological symptoms of lower limb Back Injury Back Injury

3. Back & Neurological Examination History History Examination whilst standing out of bed Examination whilst standing out of bed Gait observation Gait observation Examination in supine position Examination in supine position Examination in prone position Examination in prone position

4. Patient presenting & Back & Leg Pain

5. Patient presenting with deformity

6. Back Inspection (standing)

7. Back Inspection (Forward Flexion)

9. Back Inspection in LBP

10. Examination of forward flexion

11. Examination of Lateral Flexion

12. Examination of Back Extension

13. Examination of Rotation

14. Standing on Heels

15. Standing on Tiptoes

16. Back Examination in Supine Position Does not include back inspection Does not include back inspection SLR and Lasague maneuver should be done SLR and Lasague maneuver should be done Test the sensation (Dermatomes) Test the sensation (Dermatomes) Test muscle power (Mainly EHL) Test muscle power (Mainly EHL) Test Reflexes Test Reflexes

17. SLR : Straight Leg Raising Test

18. SLR: 0-80 degrees

19. Lasague Maneuver

20. Sensory Testing : Dermatomes

22. Clinical Picture L4 Root Lesion

23. L4 Neurological Signs

24. Clinical Picture : L5 Root Lesion

25. L 5 Neurological Signs

26. S 1 Neurologic Level

27. Clinical Picture : S 1 Root Lesion

28. L4 & L5 Lesions

29. L5 & S1 Lesions

30. Investigations in Back Examination Plain X rays: AP, Lateral, Oblique, Cone View &Tomograms Plain X rays: AP, Lateral, Oblique, Cone View &Tomograms Blood Tests: CBC, ESR, Bone Biochemistry Blood Tests: CBC, ESR, Bone Biochemistry Ct scan Ct scan Myelogram, Radiculogram Myelogram, Radiculogram MRI MRI Biopsy (CT guided or Cannulated trocar under fluoroscopy) Biopsy (CT guided or Cannulated trocar under fluoroscopy)

31. Plain X Ray : AP & Lateral

32. Plain X Ray : Oblique 45 degrees

33. Terry Dog & Scotty Dog appearance

34. Scotty dog appearance

35. Myelogram & radiculogram

36. Radiculogram Left L5 Root Compression

37. C T Scan :(Spondylolysis)=Defect in Pars Interarticularis

38. C T : Intervertebral Disc Protrusion

39. CT Myelogram

40. MRI Lumbar Spine

41. Isotope Bone Scan (Tc99m)

42. Closed Vertebral Biopsy

43. Closed vertebral biopsy

44. Closed Vertebral biopsy

45. Muscle Power Evaluation Certain muscles at lower or upper limbs Certain muscles at lower or upper limbs We test Muscle Power NOT range of joint movements! We test Muscle Power NOT range of joint movements! We give result by 0 - 5 We give result by 0 - 5

46. Hip Flexion : Iliopsoas Muscle

47. Iliopsoas Muscle power Test

48. Hip Adductor muscles( Obturator N)

49. Hip Adductors Test

50. Quadriceps Muscle (Femoral Nerve)

51. Quadriceps Muscle Test

52. Tibialis Anterior Test

53. Psychological Aspects in Back Exam