1. Waleed Awwad, MD, FRCSC

2. Anatomy Spinal Column

3. Anatomy Spinal Column

4. Anatomy Spinal Column

5. Anatomy Spinal Column

6. Anatomy Spinal Column

7. Anatomy Spinal Column

8. Anatomy Spinal Column

9. Anatomy Spinal Column

10. Anatomy Spinal Cord

11. Anatomy Spinal Cord

12. Physical exam Inspection. Gait. Palpation. Range of motion. Manipulation ( Neurologic Ex ). Special tests. Inspection. Gait. Palpation. Range of motion. Manipulation ( Neurologic Ex ). Special tests.

13. inspection Surface anatomy and alignment Coronal and sagittal alignment Shoulder level Thoracic hump Waist symmetry Pelvic obliquity Skin lesions Surface anatomy and alignment Coronal and sagittal alignment Shoulder level Thoracic hump Waist symmetry Pelvic obliquity Skin lesions

14. gait Shuffling and slap foot gait Broad-based gait Antalgic gait Shuffling and slap foot gait Broad-based gait Antalgic gait

15. palpation Spinous process for tenderness or step Musculature for spasm Spinous process for tenderness or step Musculature for spasm

16. Range of Motion Cervical spine Thoracic spine Flexion and extension, Modified Schober test and chest expansion. Lumber spine Cervical spine Thoracic spine Flexion and extension, Modified Schober test and chest expansion. Lumber spine

17. Neurologic Muscle Test Sensory exam light touch, Sharp dull discrimination, Vibration sense, Proprioception and two-point discrimination Reflexes Muscle Test Sensory exam light touch, Sharp dull discrimination, Vibration sense, Proprioception and two-point discrimination Reflexes

18. Neurologic Sensory Levels C5 over deltoid C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1 st & 2 nd toe S1 Lateral border of the foot S4-5 Perianal region Sensory Levels C5 over deltoid C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1 st & 2 nd toe S1 Lateral border of the foot S4-5 Perianal region

19. Neurologic Myotomes C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor ( lower thoracic nerve root –Beever sign ) L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors Myotomes C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor ( lower thoracic nerve root –Beever sign ) L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors

20. Neurologic Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex Abdominal reflexes Knee, ankle, planter reflex Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex Abdominal reflexes Knee, ankle, planter reflex

21. Special test Nerve Tension Tests Upper limb tension test Lower limb tension test Strait-leg raising test (SLRT) Crossed SLRT Lasegue’s test Femoral nerve stretch test Nerve Tension Tests Upper limb tension test Lower limb tension test Strait-leg raising test (SLRT) Crossed SLRT Lasegue’s test Femoral nerve stretch test

22. Special test Axial compression test Spurling’s test Nonorganic signs of Waddell Simulation test (axial compression, rotation simulation) Non anatomic tendrness Distraction sign Regional sensory or motor disturbance Overreaction Axial compression test Spurling’s test Nonorganic signs of Waddell Simulation test (axial compression, rotation simulation) Non anatomic tendrness Distraction sign Regional sensory or motor disturbance Overreaction

23. Thank you