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Physical Diagnosis of Physical Diagnosis of

Spinal Pathology Spinal Pathology
Anthony Rinella, MD Anthony Rinella, MD
Department of Orthopaedic Surgery Department of Orthopaedic Surgery
Loyola University Medical Center Loyola University Medical Center
Basic Concepts Basic Concepts
n n Standard Physical Exam Standard Physical Exam
n n What you dont want to miss: What you dont want to miss:
n n Cervical radiculopathy Cervical radiculopathy
n n MYELOPATHY MYELOPATHY
n n Boundaries of the Boundaries of the neuroforamen neuroforamen: :
Anatomy Anatomy
Facet Joints
2
n n Boundaries of the Boundaries of the neuroforamen neuroforamen: :
Anatomy Anatomy
Disk
Muscle Strength Muscle Strength
n n 5 5 Complete ROM Complete ROM Full resistance Full resistance
n n 4 4 Complete ROM Complete ROM Some resistance Some resistance
n n 3 3 Complete ROM Complete ROM Against gravity Against gravity
n n 2 2 Complete ROM Complete ROM Gravity removed Gravity removed
n n 1 1 Slight contractility Slight contractility
n n 0 0 No contractility No contractility
Cervical Spine
3
Physical Exam Physical Exam C3 C3
n n Symptoms Symptoms
n n Occipital Occipital
headache headache
n n Posterior neck Posterior neck
pain pain
n n No motor No motor
involvement involvement
Pain Distribution
Physical Exam Physical Exam C4 C4
n n Symptoms Symptoms
n n Neck pain Neck pain
n n Traps pain Traps pain
n n No motor No motor
Pain Distribution
Sensory Distribution
Physical Exam Physical Exam C5 C5
Pain Distribution
Sensory Distribution
4
Physical Exam Physical Exam C5 C5
n n Motor/Reflex Motor/Reflex
Biceps reflex
Deltoids and Biceps
Physical Exam Physical Exam C6 C6
Pain Distribution Sensory Distribution
Physical Exam Physical Exam C6 C6
Brachioradialis Reflex
n n Motor/Reflex Motor/Reflex
n Biceps and wrist
extensors
5
Physical Exam Physical Exam C7 C7
Pain Distribution Sensory Distribution
Physical Exam Physical Exam C7 C7
Motor/Reflex
Triceps and Wrist flexors
Triceps Reflex
Physical Exam Physical Exam C8 C8
n n Motor/Reflex Motor/Reflex
Grip No Reflex
6
Thoracic and Lumbar
Spine
Dermatomes Dermatomes
n n No need to memorize No need to memorize
them all: them all:
n n Learn 2 Learn 2- -3 dermatomes 3 dermatomes
with each region with each region
n n Cervical C6 Cervical C6- -8 8
n n Thoracic T4/10 Thoracic T4/10
n n Lumbar L4 Lumbar L4- -S1 S1
n n Everyone is wired Everyone is wired
differently differently
Dermatomes Dermatomes
n n Shoulder Shoulder - - C5 C5
n n Thumb Thumb - - C6 C6
n n Long Finger Long Finger - - C7 C7
n n Small Finger Small Finger - - C8 C8
n n Nipple line Nipple line - - T4 T4
n n Umbilcus Umbilcus - - T10 T10
7
Dermatomes Dermatomes
n n Medial malleolus Medial malleolus - - L4 L4
n n Dorsal Foot Dorsal Foot - - L5 L5
n n Lateral/Plantar Foot Lateral/Plantar Foot
- - S1 S1
Idiopathic Idiopathic
Scoliosis Scoliosis
n n Physical examination Physical examination
n n Observation Observation
n n Shoulder asymmetry Shoulder asymmetry
n n Waist asymmetry Waist asymmetry
n n Trunk shift Trunk shift
n n Rotation (Angle of trunk Rotation (Angle of trunk
rotation) rotation)
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n n Special tests for Special tests for spinal cord compression: spinal cord compression:
n n Lhermittes sign Lhermittes sign
n n Finger escape sign Finger escape sign
n n Jaw reflex Jaw reflex
n n Scapulohumeral reflex Scapulohumeral reflex
n n Inverted radial reflex Inverted radial reflex
n n Hoffmanns sign Hoffmanns sign
n n Hyperreflexia, clonus Hyperreflexia, clonus
Physical Exam Physical Exam Physical Exam
Scapulohumeral reflex
n n Special tests for Special tests for spinal cord compression: spinal cord compression:
n n Lhermittes sign Lhermittes sign
n n Finger escape sign Finger escape sign
n n Jaw reflex Jaw reflex
n n Scapulohumeral reflex Scapulohumeral reflex
n n Inverted radial reflex Inverted radial reflex
n n Hoffmanns sign Hoffmanns sign
Physical Exam Physical Exam Physical Exam
Hoffmanns sign