1. SPINE EXAMINATION AND SCOLIOSIS

2. SPINE EXAMINATION 3. INSPECTION (LOOK)

GAIT

• Normal walking

• Walking on tip toe(S1)

• Walking on heel(L5)

4.

2.STANDING

a)anterior

- attitude of the neck and head

-torticollis

- any swelling over anterior aspect of neck

- wasting of the muscle of thigh

- lower limbs attitude and deformity

- skin changes

-scars or sinuses

5.

b)lateral

• Normal cervical, thoracic and lumbar spine

• Gibbus (acute angulation of spine)

• Kyphosis

• Lordosis

6.

c)posterior

• Scoliosis

• Listing of trunk

• Shoulder tilt

• Pelvic tilt

• Wasting of muscle

• Skin changes over the spine (hair tuft, pigmentation)

• Scar

• Sinus

• Swelling

7. PALPATION (FEEL)

Temperature

Tenderness along the spinal process

Paravertebral muscle spasm

Step deformity

Swelling

8. MOVE

CERVICAL SPINE

Forward flexion

• Normal : 75 to 90 degrees

Extension

• Normal : 45 degrees

Right lateral flexion

• Normal : 45 to 60 degrees

Left lateral flexion

• Normal : 45 to 60 degrees

Rotation to right

• Normal : 75 degrees

Rotation to left

• Normal : 75 degrees

9.

Thoracic and lumbar spine

Forward flexion (Schobers test)

• Normal : 90 degrees

Extension

• Normal : 30 degrees

Lateral flexion to left and right

• Normal : 30 to 45 degrees

Rotation to left and right

• Normal : 45 degrees

10. SPECIAL TEST

Cervical spine :

• Compression test

• Distraction test

• Valsalva test

• Swallowing test

• Adson test

11.

COMPRESSION TEST

Press down upon the top of pts head

If there is increase pain in either cervical spine or upper extremity, note its exact distribution. So, we can locate the neurological level

A narrowing of neural foramen, pressure on the facet joints or muscle spasm can cause increase pain upon compression

12.

DISTRACTION TEST

Place the open palm of one hand under the pts chin, and the other hand is upon occiput

Then, gradually lift (distract) the head to remove its weight from the neck

To demonstrate the effect that neck traction might have help in relieving the pain by decreasing pressure on the joint capsules around the facet joints.

13.

VALSALVA TEST

Ask pt to hold his breath and bear down as if he were moving his bowels

Then, ask whether he feels any increase in pain and describe the location

This test increase intratechal pressure

If a space occupying lesion, such as a herniated disc or a tumor present in cervical canal, pt may develop pain in cervical spine secondary to increase pressure

The pain also may radiate to the dermatome distribution of cervical spine pathology

14.

SWALLOWING TEST

Difficulty or pain upon swallowing can sometimes caused by cervical spine pathology such as :

• Bony protuberance

• Bony osteophytes

• Soft tissue swelling due to hematomas, infection or tumor in ant portion of cervical spine

15.

ADSON TEST

Pull the arm downwards

Palpate the radial pulse

Turn the pts head to the same side while feeling the radial pulse

Fading of the radial pulse indicates positive thoracic outlet obstruction

16.

Thoracic and lumbar spine

• Straight leg raising test

• Sciatic stretch test

• Femoral stretch test

17.

STRAIGHT LEG RAISING TEST

With the knee extended, passively flex the hip in order to lift the lower limb

The pt will feel pain over the back and radiating to lower limb.

Watch the distribution of pain indicating the involved nerve root

Normally accepted positive if the angle of elevation is 40

• Type of surgery:

• • The Harrington system

• • Rod and sublaminar wiring

• • Posterior or anterior instrumentation

38. THANK YOU