Waleed Awwad, MD, FRCSC

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Spine Physical Exam

• Waleed Awwad, MD, FRCSC

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Column

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Anatomy

• Spinal Cord

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Anatomy

• Spinal Cord

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Physical exam

• Inspection.
• Gait.
• Palpation.
• Range of motion.
• Manipulation ( Neurologic Ex ).
• Special tests.

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inspection

• Surface anatomy and alignment
• Coronal and sagittal alignment
• Shoulder level
• Thoracic hump
• Waist symmetry
• Pelvic obliquity
• Skin lesions

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gait

• Shuffling and slap foot gait
• Broad-based gait
• Antalgic gait

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palpation

• Spinous process for tenderness or step
• Musculature for spasm

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Range of Motion

• Cervical spine
• Thoracic spine
• Flexion and extension, Modified Schober test
  and chest expansion.
• Lumber spine

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Neurologic

• Muscle Test
• Sensory exam
• light touch, Sharp dull discrimination,
  Vibration sense, Proprioception and two-point
  discrimination
• Reflexes

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Neurologic

• Sensory Levels
• C5 over deltoid
• C6 Thumb
• C7 Middle finger
• C8 Little finger
• T4 Nipple
• T8 Xiphisternum
• T10 Umbilicus
• T12 Symphysis pubis
• L4 medial aspect of calf
• L5 Web space 1st 2nd toe
• S1 Lateral border of the foot
• S4-5 Perianal region

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Neurologic

• Myotomes
• C5 Deltoid
• C6 wrist extensors
• C7 Elbow extensors
• C8 finger flexors
• T1 Small finger abductor
• ( lower thoracic nerve root Beever sign
  )
• L2 Hip flexors
• L3-4 Knee extensors
• L 4,5 S1 Knee flexion
• L5 Ankle and big toe dorsiflextion
• S1 Ankle planter flexors

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Neurologic

• Reflexes
• Biceps reflex, Brachioradialis reflex, triceps
  reflex
• Abdominal reflexes
• Knee, ankle, planter reflex

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Special test

• Nerve Tension Tests
• Upper limb tension test
• Lower limb tension test
• Strait-leg raising test (SLRT)
• Crossed SLRT
• Lasegues test
• Femoral nerve stretch test

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Special test

• Axial compression test
• Spurlings test
• Nonorganic signs of Waddell
• Simulation test (axial compression, rotation
  simulation)
• Non anatomic tendrness
• Distraction sign
• Regional sensory or motor disturbance
• Overreaction

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Thank you