1. An orthopaedic overview
Spine exam
An orthopaedic overview

2. Outline Review anatomy General exam reminder
Four conditions to illustrate the exam including overview of provocative testing

3. Cervical spine

5. Lumbar spine

6. Supporting ligaments

7. Muscles

8. Nerves: Spinal cord

9. Spinal cord injury

10. Brachial plexus

11. Sacral plexus

12. General exam reminder Look Feel Move Provocative/special testing
Kyphosis, lordosis, alignment
Gait and posture
Feel
Tenderness, swelling, neurodeficits
Move
Active and passive ROM
Provocative/special testing

13. Look: Symmetry, Alignment, Contour, Skin, Swelling, Bruising

14. Curves of spine

15. Palpate

16. Landmarks
Hyoid, thyroid cartilage, SCM, thyroid, carotid, LNs

17. Landmarks
Occiput, spinous processes, facet joints, traps

18. Landmarks

19. Landmarks
Iliac crest, posterior iliac spine, SI joints, greater trochanter, ischial tuberosity, spinous processes

20. Finger to floor distance

21. Lateral flexion
Normal 25º or measure

22. Spine rotation
Normal 30º

23. Extension
Combined segments, look for more than 5 degrees from vertical

24. Schöber maneuver

25. Cervical spine ROM (*standing)
The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position.
Cervical spine ROM measurements: optimizing the testing protocol by using a 3D ultrasound-based motion analysis system.
2005 Dec;25(12): Cephalalgia
80 degree rotation, 60 degree flexion (chest), 70 degree extension and 45 degree lateral bend

26. Chest expansion
Normal 4 to 7 cm based on gender and age

27. LS Nerve root testing
Slump test
SLR
Lasegue
Bowstring
Bragard

28. Slump test

29. Lasegue sign SLR Straight Leg Raising Test.
Sciatic Nerve Tension at 30-60° of Hip Flexion.
Dorsiflexion of Ankle May Produce Lasegue's Sign.

30. Bowstring

31. Bragard test

32. Function testing: Nerve root
T12 to L3
T12-L3 hip flexion – iliopsoas
L2-L4 knee extension – quads
L4 – tibialis anterior –dorsiflexion with inversion
L5 – heel walk
S1 – toe walk

33. Dermatomes

34. DTRs

35. Function testing: Nerve root
C5 radiculopathy
Weakness: shoulder abduction
C6 radiculopathy
Weakness: elbow flexion, wrist extension
C7 radiculopathy
Weakness: elbow extension, wrist flexion
C8 radiculopathy
Weakness: finger extension
T1 radiculopathy
Weakness: intrinsic muscles of hand

36. Compression test

37. Distraction test

38. Let’s practice