Spine Examination And Scoliosis
Upcoming SlideShare
Loading in...5
×
 

Spine Examination And Scoliosis

on

  • 16,583 views

Spine Examination And Scoliosis

Spine Examination And Scoliosis

Statistics

Views

Total Views
16,583
Views on SlideShare
16,535
Embed Views
48

Actions

Likes
4
Downloads
393
Comments
0

2 Embeds 48

http://www.slideshare.net 46
http://192.168.6.184 2

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Spine Examination And Scoliosis Spine Examination And Scoliosis Presentation Transcript

  • SPINE EXAMINATION AND SCOLIOSIS
  • SPINE EXAMINATION
  • INSPECTION (LOOK)
    • GAIT
      • Normal walking
      • Walking on tip toe (S1)
      • Walking on heel (L5)
    • 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
    • b) lateral
      • Normal cervical, thoracic and lumbar spine
      • Gibbus (acute angulation of spine)
      • Kyphosis
      • Lordosis
    • c) posterior
      • Scoliosis
      • Listing of trunk
      • Shoulder tilt
      • Pelvic tilt
      • Wasting of muscle
      • Skin changes over the spine (hair tuft, pigmentation)
      • Scar
      • Sinus
      • Swelling
  • PALPATION (FEEL)
    • Temperature
    • Tenderness –along the spinal process
    • Paravertebral muscle spasm
    • Step deformity
    • Swelling
  • 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
    • Thoracic and lumbar spine
    • Forward flexion (Schober’s 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
  • SPECIAL TEST
    • Cervical spine :
      • Compression test
      • Distraction test
      • Valsalva test
      • Swallowing test
      • Adson test
    • COMPRESSION TEST
    • Press down upon the top of pt’s 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
    • DISTRACTION TEST
    • Place the open palm of one hand under the pt’s 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.
    • 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
    • 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
    • ADSON TEST
    • Pull the arm downwards
    • Palpate the radial pulse
    • Turn the pt’s head to the same side while feeling the radial pulse
    • Fading of the radial pulse indicates positive thoracic outlet obstruction
    • Thoracic and lumbar spine
      • Straight leg raising test
      • Sciatic stretch test
      • Femoral stretch test
    • 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 <60 degrees
    • Cross sciatic tension indicate severe root irritation
    • SCIATIC STRETCH TEST
    • Following the SLR test, drop the limb for about 10 degrees to relieve tension on the irritated nerve root
    • Dorsiflex the ankle to reproduce the stretching effect on the nerve root
    • This will reproduce the sciatica pain
    • FEMORAL STRETCH TEST
    • look for lumbar root tension
    • ask the patient to lie prone
    • flex the knee
    • lift up the hip into extension
    • pain may be felt in front of the thigh and the back
    • Done to exclude higher disc prolapsed (rare)
  • NEUROLOGICAL EXAMINATION
    • UPPER LIMB
    • Tone
    • Power
    Nerve root Test C5 Elbow flexion C6 Wrist extension C7 Wrist flexion C8 Finger flexion T1 Finger abduction
    • Reflexes
      • Biceps (C5-6)
      • Brachioradialis
      • Triceps (C7-8)
    • Sensation
    Upper limb C5 - lateral forearm C6 - lateral forearm - thumb and index finger C7 - middle finger C8 - ring and little fingers - medial forearm T1 - medial elbow - distal half of the medial arm T2 - proximal half of medial arm
    • LOWER LIMBS
    • Tone
    • Power
    L1,2 Hip flexion L3,4 Knee extension L4 Dorsiflexion L5 Great toe extension S1,2 Plantarflexion
    • Reflexes
      • Knee jerk (L3-4)
      • Ankle jerk (S1-2)
      • Babinski’s reflex
      • Clonus
    • Sensation
    • Lower limb
    • L1 – groin
    • L2 – anterior thigh
    • L3 – anterior knee
    • L4 – medial aspect of leg
    • L5 – lateral aspect of leg
    • - dorsal aspect of foot
    • S1 – lateral aspect of foot
    • S2 – posterior aspect leg and thigh
    • S3,S4,S5 – perianal region
  • SCOLIOSIS
  • SCOLIOSIS
    • Definition : Lateral curvature of the spine
    • 2 broad types of deformity are defined:
      • Postural scoliosis
      • Structural scoliosis
  • Postural scoliosis
    • The deformity is secondary or compensatory to some condition outside the spine.
      • Short leg
      • Pelvic tilt due to contracture of the hip
      • Local muscle spasm a/w PID may cause a skew back (sciatic scoliosis)
      • The curve disappear when the patient sit or on forward flexion.
  • Structural scoliosis
    • Usually accompanied by bony abnormality or vertebral rotation.
    • The deformity is fixed and does not disappear with changes in position.
    • Causes:
      • Idiopathic (most cases)
      • Osteopathic (congenital)
      • Neuropathic ( poliomyelitis, cerebral palsy)
      • Myopathic ( muscular dystrophies)
      • Neurofibromatosis
  • IDIOPATHIC SCOLIOSIS
    • Constitutes about 80% of all cases of scoliosis
    • Age of onset have been used to defined 3 groups:
      • Adolescent ( ≥ 10 y/o ) - commonest
      • Juvenile ( 4 - 9 y/o )
      • Infantile ( ≤ 3 y/o )
  • ADOLESCENT IDIOPATHIC SCOLIOSIS
    • Commonest type
    • Occur mostly in girls
    • Usually present at the age of 10 – 15 y/o
  • CLINICAL FEATURES
    • Symptoms:
      • Deformity (skew back, rib hump)
    • Signs:
      • Deviation of the spine from the midline (right thoracic curves are the commonest)
      • Does not disappear with flexion
      • The hip sticks out on the concave side
      • Breast and shoulder may be asymmetrical
      • Asymmetrical rib hump on the convex side (thoracic scoliosis)
  •  
  • X-RAY
    • Full length PA and lateral view of the spine and iliac crest must be taken with the patient erect.
    • Angle of curvature is measured (Cobb’s
    • angle)
  • X-RAY
    • Risser’s sign is identified.
    • (skeletal maturity)
  • TREATMENT
    • Conservative treatment
      • Exercise
        • Have no effect on the curve but help to maintain muscle tone
          • Bracing
        • Is used for
          • All progressive curves over 20⁰ but less than 40⁰
          • Well balanced double curve
          • With younger children needing operation, to hold the curve stationary until they reach adolescence
          • To prevent recurrence after spinal fusion
  • Boston brace Milwaukee brace
    • Operative treatment
      • Indicated for curves > 40⁰
      • Type of surgery:
        • The Harrington system
        • Rod and sublaminar wiring
        • Posterior or anterior instrumentation
  • THANK YOU