Monday, 26 September 2016

Back Examination

We do back pain examination every day, but it is worth remembering how to do it properly.

- Introduction, Consent, Handwashing, Chaparone. Exposure from the waist up

- Inspection
Inspection from the back and side for:
Cervical lordosis, thoracic kyphosis and lumbar lordosis (lost with age, ank spond, acute disc prolapse).
Cafe au lait spots (neurofibromatosis), hairy patch (spinal dysraphism)
Muscle wasting

- Palpation
For temperature
  Palpate each spinous process
  Palpate sacroiliac joints
  Palpate paraspinal muscles
Percuss with a fist or tendon hammer (infection, fracture or tumour)

- Move
Lumbar: Lumbar flexion, extension and lateral flexion.
   run hands down side (lateral flexion)
   touch their toes with knees straight (flexion)
   lean backwards with knes straight (extension) - no extension in facet disease.
  Can do a modified Schobers Test - place index and middle fingers 5 centimeters apart and noting how close and far apart they move on the movements.

Lateral flexion: place your ear on your shoulder;
rotation: look over your shoulder;
flexion: put your chin on your chest;
extension: put your head back to look at the ceiling.

Fix pelvis and turn

- Special Tests
Straight leg raise - to look for sciatica
Sciatic nerve test - do SLR. When pain brought on, dorsiflex the foot = positive = sciatic!
Bowstring test - SLR. Then lower. Apply popliteal compression = symptoms.

Femoral nerve stretch test - lie prone, passively flex knee - severe = positive.
Tiptoe test - tests S1
Duck walk (on heels) - for L4 power

Neurological examination


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