• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Low back pain neuro exam
 

Low back pain neuro exam

on

  • 1,123 views

 

Statistics

Views

Total Views
1,123
Views on SlideShare
1,123
Embed Views
0

Actions

Likes
2
Downloads
0
Comments
0

0 Embeds 0

No embeds

Accessibility

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

    Low back pain neuro exam Low back pain neuro exam Presentation Transcript

    •  The exam is where you have a chance to narrow down your differential So what is your differential for Low Back pain?
    •  Lumbar Spondylosis Lumbar Spondylolisthesis Lumbar Radiculopathy Muscle Strain Sacroiliitis Scaroiliac dysfunction Spinal Stenosis Spinal tumor Cauda Equina Glut max tendinosis Greater trochanteric bursitis Hip OA Myositis ossificans
    •  Gait: able to heel and toe walk, gait intact ROM: limited AROM of the L spine in all planes Motor: 4/5 b/l hip extension and abduction 5/5 strength in the bilateral lower extremities including HF,KE, KF,AD, EHL, PF, inversion, eversion Sensation: intact to light touch in all dermatomes tested from L2- S1 bilaterally Reflexes: 2+ b/l patella and Achilles, plantar response down going, proprioception intact Palpation: Diffusely tender over lumbar paraspinals -TTP over the b/l greater trochanters and bilateral SI joint Tone: normal in the b/l LEs Lymph: no lymphadenopathy at groin or popliteal fossa Provacative tests: - SLR, seated root (slump test), Kemp, FABER testing, FADIR testing, Elys test to 0 degrees, Obers negative bilaterally
    •  Gait Eval Look at feet, ankle, and knees Heel strike, lat foot, then cross over medially to big toe off Look at shoe wear What is trendelenberg ?
    •  Trendelenberg Marilyn Monroe Weak Glut med Hip Abductor Sup gluteal N L4/L5 S1
    •  Controversial if should do this, can worsen pain Flexion 90 degrees Extension 30 degrees Lat Bending 30 degrees
    •  Muscle Grading 5 full strength and full range 4 less than full strength, full range 3 against gravity full range 2 gravity eliminated, full range 1 twitch 0 nothing
    •  HE; one of the core muscles Range 0-30 Glut max Hamstrings How isolate hamstring? Does it matter? Glut max prime mover (inf gluteal nerve L5, S1, S2) What is the most common herniation?
    •  HF Range 0-125 Iliopsoas (iliopsoas nerve L2,L3) prime hip flexor Rectus femoris, sartorius (fem nerve L2,L3,L4)
    •  KE Range degrees Quads (Rectus femoris, vastus lateralis, vastus intermedius, vastus medialis oblique) femoral nerve L2/L3/L4
    •  KF Range 0-135 Need greater than 90 degrees to stand up out of chair Hamstrings:  Semimembranosus (sciatic, tibial portion L4/L5/S1/S2  Semitendinosus (sciatic, tibail portion L4/L5/S1/S2  Biceps Femoris(Long head (sciatic, tibial portion L5/S1/S2, SHORT head common fibular portion L4/L5/S1/S2
    •  AD Range 0-20 Tibialis anterior, deep peroneal nerve L4/L5/S1
    •  EHL does toe extension Deep fibular nerve L4/L5/S1
    •  PF Range 0-50 Muscles Gastroc/Soleus primarily S1
    •  Inversion Tibialis posterior, tibial nerve L4/L5/S1 More subtle than AD
    •  Eversion Peroneus longus and brevis, superficial fibular nerve L4/L5/S1
    •  Patient with AD weakness and HE weakness, where is the lesion?
    •  Dermatomes Useful to differential muscle weakness vs nerve involvement vs myopathy
    •  Lumbar paraspinals Consistent with muscle sprain and facet issues
    •  Greater Trochanter Bursitis versus gluteus medius tendinosis
    •  SI joint SI joint or gluts
    •  What is tone? What is spasticity?
    •  What do you rule out here? What maneuver’s can you double up on Check pop fossa during SLR Check groin during FABER
    •  SLR/Seated Root Positive from 30 to 70 degrees
    •  Kemp/facet loading
    •  FABER: Flexion/Abduction, External Rotation Opp SI joint, or hip pain
    •  Ober’s Check’s TFL tightness Press on TFL to find tender points which also signifies tightness Found a lot in runners Changes running mechanics
    •  FADIR Flexion, ADduction, Internal Rotaion
    •  ELY’S test, tests quad tightness Causes pelvic tilt Putting more stress on facets
    •  Fellows now pair up