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EXAMINATION OF THE
SPINE
- Muscle hypertrophy
- Color changes
- Arterial pulse
- Postural changes
PALPATION-1
* Bone-Joint
- Spinous process
- Interspinous space
- Foramen
PALPATION-2
* SOFT TISSUES
- Swelling
- PVM
- SCMM
- Spinal nerves
- Ligaments
PALPATION-3
* Neighbouring structures
- Arterial pulse
- Lymph nodules
- Thyroid
- Trachea
- Others
ROM
- Flexion
- Extension
- Lateral Flexion (45°)
- Rotations
- Translations
- Circumflexion
NEUROLOGIC EXAMINATION
- Cervical Plexus
C1-C4
- Brachial Plexus
C5-T1
Cervical Plexus
C5: KM: biceps, brachialis, KP: lateral of the antecubital fossa, DTR:
biceps.
C6: KM: extensor carpi radialis longus and brevis, KP: middle of the
dorsum of the first phalanx of the thumb, DTR: brachioradialis.
C7: KM: triceps, KP: middle of the dorsum of the first phalanx of the
middle finger, DTR: triceps
C8: KM: flexor digitorum profundus, KP: middle of the dorsum of the
first phalanx of the little finger.
T1: KM: abductor digiti minimi, KP: medial of the antecubital
fossa.
Special Tests -1-
Distraction: To perform this test, place the open palm of one
hand under the patient’s chin, and the other hand under the
occiput. Then, gradually lift (distract) to remove its weight
from the neck, if the neck and/or arm pain decreases or
disappaers, the test is positive.
It demonstrates the effect that neck traction might have in
relieving pain by widening the foramen, decreasing pressure
on the joints capsules around the facet joints. In addition it
may help to alleviate muscle spasm by relaxing the
contracted muscles.
Special Tests -2-
Compression: To perform this test, press down upon the top of
the patient’s head while he is either sitting or lying down, if
there is an increase in pain in the neck and/or arm(s), then
the test is considered to be positive.
A narrowing of the neural foramen, pressure on the facet joints
or muscle spasm can cause increased pain. In addition, this
test may reproduce pain referred to the upper extremity
from the cervical helping to locate the neurological level of
any existing pathology.
Special Tests -3-
Valsalva: To perform this test, have the patient hold his breath
and bear down as he/she were moving his/her bowels. Then,
ask the patient whether he/she feels any increase in pain,
and if so, whether he/she can describes the location. If the
response is accurate, the test is positive.
This test increases intrathecal pressure. If a space occupying
lesion such as a herniated disc or a tumor, is present in the
cervical canal, the patient may develop pain in the cervical
spine. The pain may also radiate according to the
neurological level.
Special Tests -4-
* PVM
* Facet joints
* Spinous processes
* Interspinous spaces
ROM-1
* Flexion 20-45°
* Extension 20-45°
* Lateral flexion 20-40°
* Rotation 35-50°
ROM-2
* Sitting position,
* C7-T12: 3 sm., C7-S1 15 sm.
* Structural scoliosis does not
change in flexion
Neurologic Examination
* Slump
* Passive scapular approximation
* First thoracal nerve stretching
Special tests - 2
- Lordosis
- Scoliosis
- Swelling
- Deviation
- Muscle atrophy
INSPECTION - 2
- Muscle spasm
- Color changes
- Lipomas
- Abnormal hair
- Café au lait spots
- Postural changes
PALPATION-1
Bone – Joint:
- Spinous processes
- Interspinous spaces
- Facet joints
- İliac crests
- Coccyx
PALPATION-2
SOFT TISSUES
- Swelling
- PVM
- Ligaments
- Umblicus (L3-4)
- Sacral promontorium
PALPATION-3
VALLEIX POINTS:
1. Middle of the trochanter major ve ischial
tuberosity
2. Middle of the posteroir thigh
3. Middle of the popliteal fossa
4. Middle of the gastrocnemius muscle
5. Middle of the Achilles tendon
ROM
- Flexion
- Extension
- Lateral Flexion
- Rotations
- Circumduction
NEUROLOGIC EXAMINATION
- DTR
- Muscle testing
- Sensation
Neurologic examination
L1: KM: None, KP: inferior of the middle of the inguinal ligament.
L2: KM: iliopsoas, KP: midway of the KPs L1 and L3
L3: KM: quad. femoris, KP: medial femoral condyl, DTR: patella.
L4: KM: tibialis anterior, KP: medial malleolus
L5: KM: extensor hallucis longus, KP: third metatarsophalangeal
joint at the dorsum of the foot.
S1: KM: gastrocnemius-soleus, KP: lateral of the heel, DTR:
Achilles.
Special tests – 1-
Straight Leg Raising Test (SLRT): The patient lies on his
back (supine). The examiner raises the leg with the knee
extended straight. Normally, the angle between the leg and
the bench can reach 70° – 80° without any discomfort. If the
patient experiences pain before, the test is positive.
To differentiate between sciatic nerve stretching and
hamstring muscles tightness, lower the leg a few angle and
dorsiflex the foot in order to relax the hamstrings and to
stretch sciatic nerve. If the patient reexperiences pain along
the sciatic nerve, this is due to sciatic nerve stretching.
Special tests - 2
Contralateral SLRT: If there is low-back and/or
contralateral leg pain when the uninvolved leg is
raised the test is positive.