spine and lower limb examination

8/18/2019 Spine and Lower Limb Examination

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SPINE & LOWER

LIMBEXAMINATION

DR THIT LWIN

FACULTY OF MEDICINE & HEALTH SCIENCES

UMS


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SCREENING

Gait Walk. Normal cycle

1.Heel strike, 2.stance phase

3. Toe off, 4.swing phase

Trendelenburg

antalgic

high stepping

Arm Both hands behind the head

Leg Passive hip internal Rotation

FABER Test

Spine Spine curvature Kyphosis,Scoliosis,

Lordosis


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EXAM!A"#! #$ "%E S&!E

LOOK Scoliosis, rib hump, asymmetry

Body list, loss of normal L

lordosis,Shoulder level,,hairtuft,Paravertebral muscle

spasm ;Café Au Lait Spots,

gibbus

FEEL

Vertebra prominens

All spinous processParavertebral tenderness

Step-off in spinous processMOVE

Forward bending (40-60)

Lateral bending (40-60)

Rotation (3-18)

Spinal

excursion

test(schober’s)


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Look: cervical spine-lordosis

wry neck(torticollis)

:thoracic spine (scoliosis)

asymmetry of rib cage

:rib hump


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scoliosis


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Lumbar spine:Look lordosis

body list

Café Au Lait Spots

hairy tuftsgibbus

GIBBUS=ANGULAR

KYPHOSIS


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Feel: spinous process

vetebral prominens:paravertebral muscle spasm :

step-off in spinousprocess

Move:forward flexion

lateral bendingrotation-Patient mustsit on examination bed/


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EXAMINATION OF HIP

LOOK

4S2 AD

Scars,Sinus,Swelling,Shorting

Wasting( Atrophy)

Limb posture( Attitude), FFD,

FEEL

2T,2P

Temp, Tenderness-at GT, anterior hip

tenderness, inner side of thigh

BonyPiont-ASIS, pubic symphysis,Pulses

MOVE Active fallowed by &assive$lexion'()*+(,- Extension ()+( Abduction'()/,

Adduction'()+/, 0otation) with %ip and 1nee 2oints flexedExternal rotation'()3(,nternal rotation'()4(,

Thomas Test

Trendelenburg Test


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EXTERNAL ROTATION DEFORMITY


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A5678"#! #$

%&

A6678"#! #$

%&


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APPARENT LENGTH


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REAL LENGTH

measure from ASS to tip of medial malleolus

and compare with the other side


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"0E!6ELE!570G-S "ES"'/S,Trendelenburg’s test- As9 the sub2ect to stand

on one leg and then on the other.

#bserve pelvis tilt on the non weight bearing

side.

&ositive result:

1ey: 4S: Sound Side Sin9s


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!#0MAL LE$" %& ;EA1 A5678"#0S

%& M7S8LES #$ LE$" %&


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STANDING ON BOTH LEGS


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"0E!6ELE!5E0G

"ES") S"


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THOMAS TEST

Step 1: the patient lies supine on the

examination table. The clinician passes the palm

of his hand beneath the patients spine to identify

lumbar lordosis.

Step 2: The "normal " hip is flexed till the thigh

just touches the abdomen to obliterate the

lumbar lordosis.

Step 3: measure the angle between the affected

thigh and the table


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EXAMINATION OF KNEE

LOOK Scar, sinus ,swelling,wasting (Atrophy)

(quardriceps),deformity

Genu varus/valgus/recurvatum

FFD

FEEL Temp , tenderness, bony points-

Tibial tuberosity/patella tendon/inferior pole

of patella/collateral ligaments/quardricep

tendon

MOVE Flexion (0-135)Extension (0-10)

Patella tapCollateral stress

test

Lachmann’s test

Anterior drawer

Posterior drawer


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"%E 1!EE >#!"

Loo9: for Genu valgum- Genu

varum: fixed flexion orrecurvatum

?uadriceps muscle wasting

6on@t forget to loo9 the popliteal

fossa $eel : "enderness

"emperature changes

Swelling

*.


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PATELLAR TAP

ndication) "o 9now about the presence of excessive

fluid in the 9nee 2oint li9e serous effusion- blood or pus. &osition: &atient lying down- with 9nee extended.

Procedure:*. Empty the supra patellar pouch by gradual application of

pressure from above towards the 9nee 2oint = hold the

hand to prevent possible return flow.+. "ap the patella down with the finger of the other hand

Result- f the &atella returns after touching the $emoralcondyles-

&atellar tap is positive = so some fluid is present in the 9nee 2oint.Patellar tap is negative in normal subjects- as there is no

excessive fluid in the 9nee 2oint.


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A patellar tap


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M#


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SPINAL MOVEMENTS- CONTINUED

Lumbar vertebrae: $ive ($ in number

$lexion- Extension- 5ending to right and Lt

%acral vertebrae: $ive ($ in number All the vertebrae are fused together- so no movement is

possible

Cocc&': contains four', fused vertebrae


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S&!AL 8#06

"he spinal cord extends from the foramen magnum to the

lower border of L* vertebra in adults and L4 in children. "he posterior and anterior nerve roots at each spinal level 2oin

one another and exit through the inter vertebral foramina

forming spinal nerves.

Spinal nerves are 4*pairs in total.

)cervical *+)thoracic /)lumbar

/ sacral *)coccygeal


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A) !E7"0AL S"#!)!E0


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C.TE.%+/. +.CREA%E0 *1 0/R%+2LE3+/.

/2 2//T)

0) R//T TE.%+/. REL+E4E0 *1 2LE3+/.


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LOOK PATIENT

FACE AS WELL

AS RANGE OFSLR


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EXAMINATION OF ANKLE & FOOT

LOOK Deformity:Flat foot (Pes planus)High arch (Pes

Cavus),bunion, tophi, claw toes, hammer toe

CTEV,

FEEL "emp-5ony prominences-&ulsations)anterior tibial-dorsalis pedis-peroneal-Archilles tendon) "enderness-palpable gap

MOVE Ankle joint-dorsiflexion,planter flexionSub-talr joint- inversion,eversion

Mid-tarsal joint- Addtion, abduction

Thompsom Test


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THOMPSOM’S TEST


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THANK YOU

spine and lower limb examination

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