Algortihm 3 for examination of Spine cases


Spine Cases 
Introduction with the patient.
Exposure – whole body
Hand scrubbing
Look- Standing Patient
Attitude of the body / extremities – Patient sitting comfortably / Ulnar Deviation of wrist and
                                                         fingers
Look
Alignment       -           Front        Head at centre
     Both shoulders and Pelvis are leveled,
                                                     No wasting of Quadriceps muscles
                                                      Patella facing forward and at equal height
Leg, foot and toes look normal with normal        
overlying skin
                                    Side          Elbows straight overlying greater trochanter
                                                     Transverse Loin Creases
     Knee Straight
      Foot Arches maintained 
                                    Back               
Normal Vertebral alignment
 Normal overlying skin on back with no dimpling , tuft of hair
  and swelling
  Calf symmetrical with normal overlying skin
  Heel has – Normal varus
 Feel                                        C- Spine / Thoracic and Lumbar Spine
Temperature – Normal
Superficial Palpation
Bony Palpation
Movement –                            Global Reduction in movement

Gait                                         Normal / Foot Drop Gait ,
Tip toe , heel walking ,

Squating                                  heel at the same level

Standing –                              Special tests -Trendelenburg test
Sitting   -                                 Upper Extremity Examination /Lower Extremity
                 
Look –                                     Skin
                                                Muscle Wasting

Feel –                                      Temperature
                        Tenderness
                        Lymph Nodes


Move                                       Shoulder / Elbow / Wrist and Hands
Hip / Knee / Ankle / Toes                   



Lie down Patient
SLR – decrease to < 60 degrees bilaterally not true nerve root sign                                                
Measurement – LLD , Quadriceps Wasting
                                   
Neurovascular Assessment

Sensory Examination             L 2 – S 5  
Motor Examination  -               Global muscle weakness
Power of the Muscles –                      
                                    Supine             Quadriceps ,
TA / EHL /EDC / TP / Peronei
                                                Lateral             Abductor /Adductor
Prone               Gastrosoleus / FHL/FDC /Hamstring/Gluteal Maixums /Medius/Minimus


Reflexes
Jaw Jerk
Hoffman’s sign
Finger Escape sign
Inverted Radial Reflex

Vascular Examination – DPA / PTA on supine position






























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