Clinical evaluation of spine

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Clinical evaluation of spine

  1. 1. Can we have some cell phone ettiquette, please ?Can we have some cell phone ettiquette, please ?
  2. 2. CLINICAL EXAMCLINICAL EXAM History TakingHistory Taking Keep the question simpleKeep the question simple Ask one at a timeAsk one at a time Get an answer before proceeding to next oneGet an answer before proceeding to next one Avoid putting words into patients mouthAvoid putting words into patients mouth Give equal value to awkward pointsGive equal value to awkward points
  3. 3. CLINICAL EXAMCLINICAL EXAM MANDATORY QUESTIONSMANDATORY QUESTIONS CERVICAL REGIONCERVICAL REGION ? VERTIGO,BLACKOUT,DROP ATTACK? VERTIGO,BLACKOUT,DROP ATTACK H/O URT INFECTION (IN JUNIORS)H/O URT INFECTION (IN JUNIORS) H/O RHTD.ARTHRITIS,STEROIDS,ANTICOAGULANTSH/O RHTD.ARTHRITIS,STEROIDS,ANTICOAGULANTS
  4. 4. CLINICAL EXAMCLINICAL EXAM THORACIC REGIONTHORACIC REGION ? NEUROLOGICAL SIGNS IN LOWER? NEUROLOGICAL SIGNS IN LOWERLIMBSLIMBS LUMBAR REGIONSLUMBAR REGIONS ? PERINEAL ANAESTHESIA? PERINEAL ANAESTHESIA ? CHANGE IN MICTURITION HABITS? CHANGE IN MICTURITION HABITS ? SPHINCTER TROUBLE? SPHINCTER TROUBLE
  5. 5. CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK SymptomsSymptomsPain-Neck itself / Ref. To shoulder & armsPain-Neck itself / Ref. To shoulder & arms Relation to PostureRelation to Posture StiffnessStiffnessIntermittent / continuousIntermittent / continuous DeformityDeformityNeck fixed in flexionNeck fixed in flexion
  6. 6. CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK Numbness, tingling & weaknessNumbness, tingling & weakness Headache-suspect other causesHeadache-suspect other causes ““Tension”- ‘Try to read’ the patientsTension”- ‘Try to read’ the patients Target zone for psychosomatic illnessTarget zone for psychosomatic illness TWO ARMS = ONE NECKTWO ARMS = ONE NECK (If both arms are affected suspect(If both arms are affected suspectneck)neck)
  7. 7. CLINICAL EXAM OF NECKCLINICAL EXAM OF NECK LookLook - Deformity- Deformity FeelFeel - Tender areas in muscles /front- Tender areas in muscles /front- Cervical rib- Cervical rib MoveMove - Forw.flex / ext / lat.flex / rotation- Forw.flex / ext / lat.flex / rotation PulsesPulses - Radial - at rest – on traction- Radial - at rest – on traction NeuroNeuro - Mandatory in upper limbs- Mandatory in upper limbs X-rayX-ray - AP / Lateral- AP / Lateral
  8. 8. EXAMINATIONFLEXION / EXTENSION / ROTATIONTILT / TESTING POWER ELBOW & WRIST
  9. 9. READING A LAT.FILM OF C.SPINEREADING A LAT.FILM OF C.SPINE ALIGNMENTALIGNMENT BONY INTEGRITYBONY INTEGRITY CARTILAGINOUS SPACESCARTILAGINOUS SPACES SURROUNDING SOFT TISSUESSURROUNDING SOFT TISSUES  PRE VERTEBRAL SOFT TISSUEPRE VERTEBRAL SOFT TISSUESHADOWSHADOW BLOOD / FLUID / PUS / TUMOR MATERIALBLOOD / FLUID / PUS / TUMOR MATERIAL
  10. 10. ANATOMY OF C - SPINE
  11. 11. TORTICOLLISNATURAL HISTORYEARLY DEFORMITYSTERNOMASTOID DIVIDEDRESULT AFTER SURGERY
  12. 12. SPASMODIC TORTICOLLIS - NOTE THE MUSCLE IN SPASM
  13. 13. CERVICAL DISC LESIONSTRAIGHTENING OF LORDOSIS / MRI SCAN SHOWS C5/6 DISC
  14. 14. CERVICAL SPONDYLOSISDISC DEGENERATION & OSTEOPHYTES
  15. 15. PYOGENIC INFECTIONDESTRUCTION TAKES 2 TO 3 WEEKS
  16. 16. RHEUMATOID ARTHRITISBEWARE OF ATLANTO - AXIAL SUBLUXATION
  17. 17. NEURALGIC AMYOTROTHYWASTING – WEAKNESS MAY BE PERMANENT
  18. 18. CERVICAL RIBUNILATERAL / BILATERAL PULSATING LUMP / TEACH SHRUGGING EXCERCISES
  19. 19. MALIGNANT DEPOSITSNOTE THE PAN - COAST TUMOUR
  20. 20. OTHER CAUSES OF NECK & ARM PAINCARPAL TUNNEL SYNDROMESUPRA SPINATUS TENDON LESIONCERVICAL TUMOURSTHORACIC OUTLET SYNDROME
  21. 21. THORACIC SPINETHORACIC SPINE LOOKLOOK -- DEFORMITIESDEFORMITIES FEELFEEL -- TENDERNESSTENDERNESS NEUROLOGYNEUROLOGY -- TB / PYOGENIC /TB / PYOGENIC /-- METASTASISMETASTASIS TRACKING OF COLD ABSCESSTRACKING OF COLD ABSCESS
  22. 22. CONGENITAL MYELODYSPLASIA
  23. 23. SCHEUERMANN’S THORACIC KYPHOSIS
  24. 24. SCHEUERMANN’S LUMBAR KYPHOSIS
  25. 25. PARALYTIC SCOLIOSIS
  26. 26. OTHER CAUSES OF SCOLIOSIS
  27. 27. CLINICALEVALUATION
  28. 28. ANATOMY OF SPINALNERVESNOTE THE RELATIONSHIPOF DISC TO THE ROOTS
  29. 29. YOU STAND ON S1& SIT ON S3
  30. 30. PRIMARY MUSCLE ACTIONPRIMARY MUSCLE ACTION HIP FLEXION – PSOAS / ILIACUS = L 2 / 3HIP FLEXION – PSOAS / ILIACUS = L 2 / 3 KNEE EXTEN – VAST INTER = L 3 / 4KNEE EXTEN – VAST INTER = L 3 / 4 ANKLE FLEX – SOLEUS = S 1 / 2ANKLE FLEX – SOLEUS = S 1 / 2 EXCEPTIONEXCEPTION E H L – L 5 ROOTE H L – L 5 ROOT
  31. 31. EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE PAIN - SCIATICA /PAIN - SCIATICA /  COUGH / SNEEZECOUGH / SNEEZE STIFFNESS – DISC / A S / ARTHRITISSTIFFNESS – DISC / A S / ARTHRITIS DEFORMITYDEFORMITY NUMBNESS & / PARAESTHESIANUMBNESS & / PARAESTHESIA ASKASK  WALKING / STANDING /WALKING / STANDING /  RESTREST ? URETHRAL DISCHARGE/ DIARRHOEA /? URETHRAL DISCHARGE/ DIARRHOEA /SORE EYESSORE EYES
  32. 32. EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE LOOKLOOK – SKIN SCARS / PIGMENTATION– SKIN SCARS / PIGMENTATIONABNORMAL HAIRS / UNUSUAL SKIN CREASEABNORMAL HAIRS / UNUSUAL SKIN CREASESHAPE & POSTURE AFFECTEDSHAPE & POSTURE AFFECTED FEELFEEL – BONYSTRUCTURES / I V TISSUE / PARA– BONYSTRUCTURES / I V TISSUE / PARAMUSCLESMUSCLES MOVEMOVE – FLEX / EXTD / LAT. BEND / ROTATION– FLEX / EXTD / LAT. BEND / ROTATIONCHEST EXPANSIONCHEST EXPANSION MUSCLE POWERMUSCLE POWER ––STAND ON TOESSTAND ON TOES (PLANTAR FLEXION)(PLANTAR FLEXION)ROCK BACK ON HEELSROCK BACK ON HEELS (DORSIFLEXION)(DORSIFLEXION)
  33. 33. EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE IMAGING –IMAGING – X – RAYSX – RAYS PLEASE PREPARE BOWELPLEASE PREPARE BOWEL AP / LATERAL / OBLIQUE & P A VIEW FOR S I Jt.AP / LATERAL / OBLIQUE & P A VIEW FOR S I Jt. COMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHYBONE TUMOUR / Sp.CANAL STENOSISBONE TUMOUR / Sp.CANAL STENOSIS MRI SCANMRI SCAN – FOR SOFT TISSUE– FOR SOFT TISSUE BEWARE FALSE POSITIVE FINDINGS ( >30%)BEWARE FALSE POSITIVE FINDINGS ( >30%)
  34. 34. EXAMINATIONSTANDS WITH A TILT / LTD FORW. FLEX / LAT. FLEX
  35. 35. EXAMINATIONMETHOD OF MEASURING EXCURSION
  36. 36. LYING ON HIS BACKSLRSTRETCH+HIP & KNEEEHLSENSATIONREFLEX
  37. 37. HERNIATED LUMBAR DISCCHARACTERISTIC POSTURE
  38. 38. L3/4 DISCL4 ROOTL4/5 DISCL5 ROOTL5/S1 DISCS1 ROOT
  39. 39. SPINE TUBERCULOSISSHOWING PROGRESSIVE DESTRUCTION
  40. 40. SPINE TUBERCULOSISPATHOLOGICAL DESTRUCTION & ABSCESS
  41. 41. PYOGENIC SPONDYLITISEVIDENCE OF BONE DESTRUCTION + +
  42. 42. MOBILE SCOLIOSISPOSTURAL FLEXIONSHORTLEG SITTINGPROLAPSEDDISC ONTTMT
  43. 43. FIXED SCOLIOSISINCREASING CURVE OVER THE YEARS
  44. 44. INFANTILE THORACICADOLESCENT THORACICTHORACO - LUMBARLUMBARCOMBINEDIDIOPATHIC SCOLIOSIS
  45. 45. TRANSITIONAL LUMBO-SACRAL VERTIBRA
  46. 46. SPODYLOLYSIS & SPONDYLOLISTHESIS
  47. 47. ANKYLOSING SPONDYLITISREDUCED CHEST EXPANSION / OSSIFIED LIGAMENTS
  48. 48. DEGENERATIVE OSTEO ARTHRITIS
  49. 49. SPINAL CANALSTENOSISCLINICAL FEATURES
  50. 50. MECHANICAL CAUSES OF LOW BACK PAINGOOD POSTURE & POOR POSTURE
  51. 51. EXAMINATION OF LUMBAR SPINEEXAMINATION OF LUMBAR SPINE EXTENSIVE LAB TESTEXTENSIVE LAB TESTWHEN CLINICIAN SUSPECTSWHEN CLINICIAN SUSPECTSMALIGNANCYMALIGNANCYMETABOLIC DISTURBANCEMETABOLIC DISTURBANCECHRONIC INFECTIONCHRONIC INFECTION
  52. 52. TUMOURS OF SPINEOSTEIOD OSTEOMA HEMANGIOMABENIGN LESIONS
  53. 53. MYELOMASECONDARYTUMOURS
  54. 54. EXTRA DURALFIBROBLASTOMAEXTRAMEDULLARYMENINGIOMAINTRA MEDULLARYEPENDYMOMA
  55. 55. CHRONIC BACKACHECHRONIC BACKACHETB OM DISCITISSI Jt. TB OST. CONDENS. ILII
  56. 56. PSYCHOSOMATIC MANIFESTATION
  57. 57. “ From the unreal lead me to the real !From darkness lead me to light !From death lead me to immortality !Brihad – aranyaka Upanishad
  58. 58. Thank YouThank You© Dept. of© Dept. of OrthopaedicsOrthopaedics,,Govt. Medical College,Govt. Medical College, ThrissurThrissur

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