PRESENTED BY: Ita Puspita Dewi (C11106105) Siti Zaharah Bt. Gusti Ruslan (C11106246) Muh.

Farid Huzein (C11107140) Hasmia (C11107208) Aimi Haniza Zainal (C11107352) Andi Irhamnia Sakinah (C11108263) Yunialthy Dwia Pertiwi (C11108303) ADVISORS: dr. Muhammad Petrus Johan dr. Erick Gamaliel Amba dr. Evan Orthopaedic and Traumatology Department Medical Faculty of Hasanuddin University Makassar 2012

SPINE

INTRODUCTION

General Principles The physical examination of the spine should follow the usual pattern of orthopedics examinations. a. Inspection of relevant body parts b. Palpation of relevant structures c. Tests for range of motion d. Specific/more extensive neurologic and vascular examination Provocative Maneuvers

1. AAOS Comprehensive Orthopaedics Review, Section 7 Spine, Chapter 63 Physical Examination of The Spine by Alan S. Hilibrand, MD

CERVICAL SPINE

Inspection

Any deformity is noted. Wry neck, due to muscle spasm, may suggest a disc lesion, an inflammatory disorder or cervical spine injury; but it also occurs with intracranial lesions and disorder of the eyes or semicircular canal. Neck stiffness is usually fairly obvious.

1..Apleys

Palpation
The front of the neck is most easily palpated with the patient seated and the examiner standing behind him or her. The best way to feel the back of the neck is with the patient lying prone and resting his/her head over a pillow; this way the patient can relax and the bony structures are more easily palpated. Feel for tender areas or lumps and note if the paravertebral muscles in spasm 1..Apleys

Palpation

1.. Apleys

Range of Motion

Forward flexion, extension, lateral flexion and rotation are tested, and the sholder movement. Range of motion normally diminishes with age, but even in the older patient movement should be smooth and pain free.

1.. Apleys

Range of Motion

1. Apleys

Neurovascular Distal
Neurological examination of the upper limb is mandatory in all cases. Muscle power, reflexes and sensation should be carefully tested; even small degrees of abnormlaity may be significant. The pulses of brachial, radial, and ulnar should be palpated. Absent/ diminished of the pulses lead to vascular injury or compromise. 1. Apleys

Neurovascular Distal

1. Netters

PROVOCATIVE TEST

The Spurling Maneuver

Very specific for nerve root compression in the lateral recess and/or foraminal zone. Applying an axial load to the neck while it is rotated toward the side of the pathology and placed into extension. Positive when holding the patient in this position for 30 seconds recreates radicular symptoms, which may consist of pain, numbness, tingling, or paresthesias into the appropriate dermatome. These findings should occur ipsilateral to the lesion.

1. AAOS Comprehensive Orthopaedics Review, Section 7 Spine, Chapter 63 Physical Examination of The Spine by Alan S. Hilibrand, MD

Lhermitte Sign
Shock-like sensations radiate down the spinal axis into the arms and/or legs when the neck of a patient with cervical spinal cord compression is brought into extreme flexion or extension, causing stretch and direct compression of the spinal cord. In patients with acute radiculopathy, this maneuver may reproduce the radiculopathy Specific (not sensitive) for myelopathy Neither specific nor sensitive for identifying cervical radiculopathy
1. AAOS Comprehensive Orthopaedics Review, Section 7 Spine, Chapter 63 Physical Examination of The Spine by Alan S. Hilibrand, MD

Another Special Test

Exam Distraction Technique Upward distracting force Clinical Application Relief of symptoms indicates foraminal compression of nerve root Pain in or radiating to legs indicates meningeal irritation/infection Pain reduction with knee flexion indicates meningeal irritation

Kernig

Supine: flex neck

Brudzinski

Supine: flex neck, hip flex