1. Examination of SPINE

3. wide base gait – cervical myelopathy

4. waddling gait – proximal myopathy

5. Walking on tip toe – S1 weakness

7. ii. Increased kyphosis (posterior convexity of the spine) > senile kyphosis (with osteoporosis, osteomalacia or pathological fracture) > Scheuermann’s disease (osteochondritis involving one or more of the vertebrae) > ankylosing spondylitis

8. iii. Gibbus (angular kyphosis) > fracture > tuberculosis of the spine > congenital abnormality

9. iv. Lumbar curvature > flattening or reversal of lumbar lordosis : - prolapsed intervertebral disc - osteoarthritis of the spine - infection of vertebral bodies - ankylosing spondylitis > increase in lumbar lordosis - may be normal (esp. in women) - spondylolisthesis - secondary to increased thoracic curvature or to flexion deformity of the hips

10. (b) Look from behind i. listing of trunk (due to muscle spasm) ii. Scoliosis (lateral curvature of spine) - postural : scoliosis disappears with forward flexion of the spine - structural : scoliosis persists with forward flexion of the spine and a rib hump presents iii. Shoulder tilt iv. Pelvic tilt

11. v. Skin changes over the spine - hair tuft (spina bifida) - sinus - colour changes or pigmentation (neurofibroma) - scar vi. Swelling vii. Prominent crease of the trunk viii. Wasting of glutei, hamstrings and calf muscles

13. paravertebral muscle spasm

14. sacro-iliac joint tenderness

15. step deformity (spondylolisthesis)

16. Slide the fingers down the lumbar spine on to the sacrum

19. Anchor the top of the tape with a finger and ask the patient to flex as far as he can

20. Measure the increase in the distance between the 2 points which indicate lumbar excursion

22. 2. Extension - ask the patient to arch his back - assist him by steadying the pelvis and pulling back on the shoulder - normal : 30°

23. 3. Lateral flexion - ask the patient to slide the hands down the side of each leg in turn - record the point reached from the floor or - measure the angle - normal : 30-45°

24. 4. Rotation - patient seated to fix the pelvis or pelvis fixed by examiner - ask the patient to twist round to each side - normal : 45°

25. Cervical spine Flexion - ask the patient to bend the head forwards - chin should be able to touch the chest - normal : 80°

26. 2.Extension - ask the patient to look up and back - normal : 50°

27. 3. Lateral flexion - ask the patient to touch his shoulder with the ear - involve atlanto-axial and atlanto-occipital joints - normal : 45°

28. 4. Rotation - ask the patient to look over his shoulder - normal : 80° - restricted and painful in cervical spondylitis

30. normotonia

32. iv. Fingers - flexion : C7,C8 - extension : C7,C8 - abduction : C8,T1 - adduction : C8,T1

33. 3. Reflex - biceps jerk : C5,C6 - triceps jerk : C7,C8 - brachioradialis (supinator) jerk : C5,C6

34. 4. Sensation C5 – lateral arm C6 – lateral forearm - thumb & index finger C7 – middle finger C8 – ring&little finger T1 – medial arm

36. normotonia

38. iii. Ankle - plantar flexion : S1,S2 - dorsiflexion : L4,L5 iv. Tarsal joint - eversion : L5,S1 - inversion : L5,S1

39. 3. Reflex - knee jerk : L3,L4 - ankle jerk : S1,S2 - plantar reflex : L5,S1,S2

40. 4. Sensation L1 – groin L2 – anterior thigh L3 – anterior knee L4 – medial leg L5 – lateral leg - medial of foot dorsum S1 – lateral of foot dorsum - heel and foot sole S2 – posterior leg and thigh

42. raise the leg from the couch with the knee extended until the patient experiences pain (over the back & may radiate to the lower limb)

43. Distribution of the pain indicating the involved nerve root

44. Positive if the angle < 60°

45. Cross sciatic tension : severe root irritation(pain on the affected side when raising the unaffected leg)

47. Drop the limb about 10° to relieve tension on the irritated nerve root

49. Patient should be prone

50. Flex the patient’s knee and lift the hip into extension

51. Pain may be felt in front of the thigh and in the back