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Clinical evaluation of spine
1.
2. Can we have some cell phone ettiquette, please ?Can we have some cell phone ettiquette, please ?
3. CLINICAL EXAMCLINICAL EXAM
History TakingHistory Taking
Keep the question simpleKeep the question simple
Ask one at a timeAsk one at a time
Get an answer before proceeding to next oneGet an answer before proceeding to next one
Avoid putting words into patients mouthAvoid putting words into patients mouth
Give equal value to awkward pointsGive equal value to awkward points
5. CLINICAL EXAMCLINICAL EXAM
THORACIC REGIONTHORACIC REGION
? NEUROLOGICAL SIGNS IN LOWER? NEUROLOGICAL SIGNS IN LOWER
LIMBSLIMBS
LUMBAR REGIONSLUMBAR REGIONS
? PERINEAL ANAESTHESIA? PERINEAL ANAESTHESIA
? CHANGE IN MICTURITION HABITS? CHANGE IN MICTURITION HABITS
? SPHINCTER TROUBLE? SPHINCTER TROUBLE
6.
7. CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK
SymptomsSymptoms
Pain-Neck itself / Ref. To shoulder & armsPain-Neck itself / Ref. To shoulder & arms
Relation to PostureRelation to Posture
StiffnessStiffness
Intermittent / continuousIntermittent / continuous
DeformityDeformity
Neck fixed in flexionNeck fixed in flexion
8. CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK
Numbness, tingling & weaknessNumbness, tingling & weakness
Headache-suspect other causesHeadache-suspect other causes
““Tension”- ‘Try to read’ the patientsTension”- ‘Try to read’ the patients
Target zone for psychosomatic illnessTarget zone for psychosomatic illness
TWO ARMS = ONE NECKTWO ARMS = ONE NECK
(If both arms are affected suspect(If both arms are affected suspect
neck)neck)
9. CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK
LookLook - Deformity- Deformity
FeelFeel - Tender areas in muscles /front- Tender areas in muscles /front
- Cervical rib- Cervical rib
MoveMove - Forw.flex / ext / lat.flex / rotation- Forw.flex / ext / lat.flex / rotation
PulsesPulses - Radial - at rest – on traction- Radial - at rest – on traction
NeuroNeuro - Mandatory in upper limbs- Mandatory in upper limbs
X-rayX-ray - AP / Lateral- AP / Lateral
36. EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE
LOOKLOOK – SKIN SCARS / PIGMENTATION– SKIN SCARS / PIGMENTATION
ABNORMAL HAIRS / UNUSUAL SKIN CREASEABNORMAL HAIRS / UNUSUAL SKIN CREASE
SHAPE & POSTURE AFFECTEDSHAPE & POSTURE AFFECTED
FEELFEEL – BONYSTRUCTURES / I V TISSUE / PARA– BONYSTRUCTURES / I V TISSUE / PARA
MUSCLESMUSCLES
MOVEMOVE – FLEX / EXTD / LAT. BEND / ROTATION– FLEX / EXTD / LAT. BEND / ROTATION
CHEST EXPANSIONCHEST EXPANSION
MUSCLE POWERMUSCLE POWER ––
STAND ON TOESSTAND ON TOES (PLANTAR FLEXION)(PLANTAR FLEXION)
ROCK BACK ON HEELSROCK BACK ON HEELS (DORSIFLEXION)(DORSIFLEXION)
37. EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE
IMAGING –IMAGING – X – RAYSX – RAYS PLEASE PREPARE BOWELPLEASE PREPARE BOWEL
AP / LATERAL / OBLIQUE & P A VIEW FOR S I Jt.AP / LATERAL / OBLIQUE & P A VIEW FOR S I Jt.
COMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHY
BONE TUMOUR / Sp.CANAL STENOSISBONE TUMOUR / Sp.CANAL STENOSIS
MRI SCANMRI SCAN – FOR SOFT TISSUE– FOR SOFT TISSUE
BEWARE FALSE POSITIVE FINDINGS ( >30%)BEWARE FALSE POSITIVE FINDINGS ( >30%)