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Lumbar Spine Examination: Difference between revisions

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==Inspection==
==Standing==
*Gait
*Gait
*Stature
*Stature
*Build
*Build
*Romberg
*Transitioning movements
*Transitioning movements
*Lumbar alignment coronal plane
*Posture and alignment
*Lumbar alignment sagittal plane
**Thoracolumbar alignment coronal and sagittal plane
**Lumbar alignment coronal and sagittal plane
**Pelvic alignment
**Foot alignment
*Movement
**Forward flexion
**Extension
**Side flexion
**Compound extension and rotation
*Trendelenburg
 
==Sitting==
*Breathing
*Pelvic alignment
*Pelvic alignment
*Thoracolumbar alignment coronal plane
*Slump test
*Thoracolumbar alignment sagittal plane
 
==Lying==
*Skin drag and rolling
*Allodynia to cold and pin prick
*Palpation
**Vertebral springing tenderness
**Rotation testing
**Bony landmarks: Iliac crest, PSIS, LPSL, sacroiliac joint
**Soft tissue: sacrotuberous and sacrospinous ligaments, gluteus medius and gluteus minimus, piriformis, iliopsoas, quaratus lumborum, hamstring origin
*SIJ provocation testing: distraction, thigh thrust, sacral thrust, compression
*Hip joint range of motion
*Special tests
**Straight leg raise
**Femoral stretch test
**Iliopsoas length test and tenderness
**Direction preference
**Centralisation phenomenon
*Neurological examination
**Tone
**[[Motor System Examination|Power]]: hip flexion (L2), hip adduction (L3), ankle dorsiflexion (L4), great toe extension (L5), knee flexion (S1)
**[[Reflex Testing|Reflexes]]: knee (L3, L4), [[:File:Medial hamstring reflex.PNG|medial hamstring]] (L5), achilles (S1) <ref>{{#pmid:23087820}}</ref>
**[[Pain Oriented Sensory Testing|Sensation]]: L2, L3, L4 (medial lower leg 88%), L5 (first dorsal digit 82%), S1 (lateral 5th digit 88%), S2, S3. <ref>{{#pmid:8235861}}</ref> Don't forget sacral sensation if bladder/bowel symptoms, bilateral leg weakness/sensory change.
**Plantar reflexes
**Co-ordination: Rombergs, tandem Romberg, etc.
==Paediatric Examination of the Whole Spine==
A consensus approach to the MSK examination in children was developed by Foster et al in 2011.<ref>{{#pmid:21954040}}</ref> They did not differentiate between cervical, thoracic, and lumbar spine. The <u>underlined</u> components are those that are additional to the adult examination. The ''italicised'' components are those that the doctor should be aware of but not necessarily competent in.
 
'''''With the patient standing:'''''


==Palpation==
* Look at the spine from the side and from behind
*Skin drag
* <u>Look at the skin and natal cleft</u>
*Skin rolling
* <u>Look at limb and trunk proportions</u>
*Vertebral springing tenderness
* <u>Look at the face and jaw profile</u>
*Rotation testing
* Feel the spinal processes and paraspinal muscles and <u>Temporomandibular joints (TMJs)</u>
*Iliac crest palpation
* Assess movement: lumbar flexion and extension and lateral flexion; cervical flexion, extension, rotation and lateral flexion, <u>thoracic rotation</u>
*PSIS palpation
* <u>Assess TMJ opening</u> 
*Long dorsal sacroiliac and sacrotuberous ligament palpation
* <u>Options – Schober’s test, “stork test”</u>
*Iliopsoas palpation
*Gluteus medius, minimus, and piriformis palpation


==Movement==
'''''With the patient sitting on couch (standing in younger child):'''''
*Forward flexion
*Extension
*Side flexion
*Rotation
*Extension/Rotation test


==Special Tests==
* Assess thoracic rotation
*Slump test
 
*Straight leg raise
'''''With the patient lying on couch:'''''
*Femoral stretch test
*Sacroiliac joint provocation testing
*Iliopsoas length test
*Provocation test


==Neurological Exam==
* Perform straight leg raising and dorsi-flexion of the big toe
*Tone
* Assess limb reflexes
*Power
* <u>Option – leg length, hypermobility</u>, sacroiliac joint palpation (Faber’s / Patrick’s test)
*Reflexes - knee (L3, L4), [[:File:Medial hamstring reflex.PNG|medial hamstring]] (L5), achilles (S1) <ref>{{#pmid:23087820}}</ref>
*Sensation
*Plantar reflexes


==References==
==References==

Latest revision as of 14:02, 13 March 2022

This article is a stub.

Standing

  • Gait
  • Stature
  • Build
  • Romberg
  • Transitioning movements
  • Posture and alignment
    • Thoracolumbar alignment coronal and sagittal plane
    • Lumbar alignment coronal and sagittal plane
    • Pelvic alignment
    • Foot alignment
  • Movement
    • Forward flexion
    • Extension
    • Side flexion
    • Compound extension and rotation
  • Trendelenburg

Sitting

  • Breathing
  • Pelvic alignment
  • Slump test

Lying

  • Skin drag and rolling
  • Allodynia to cold and pin prick
  • Palpation
    • Vertebral springing tenderness
    • Rotation testing
    • Bony landmarks: Iliac crest, PSIS, LPSL, sacroiliac joint
    • Soft tissue: sacrotuberous and sacrospinous ligaments, gluteus medius and gluteus minimus, piriformis, iliopsoas, quaratus lumborum, hamstring origin
  • SIJ provocation testing: distraction, thigh thrust, sacral thrust, compression
  • Hip joint range of motion
  • Special tests
    • Straight leg raise
    • Femoral stretch test
    • Iliopsoas length test and tenderness
    • Direction preference
    • Centralisation phenomenon
  • Neurological examination
    • Tone
    • Power: hip flexion (L2), hip adduction (L3), ankle dorsiflexion (L4), great toe extension (L5), knee flexion (S1)
    • Reflexes: knee (L3, L4), medial hamstring (L5), achilles (S1) [1]
    • Sensation: L2, L3, L4 (medial lower leg 88%), L5 (first dorsal digit 82%), S1 (lateral 5th digit 88%), S2, S3. [2] Don't forget sacral sensation if bladder/bowel symptoms, bilateral leg weakness/sensory change.
    • Plantar reflexes
    • Co-ordination: Rombergs, tandem Romberg, etc.

Paediatric Examination of the Whole Spine

A consensus approach to the MSK examination in children was developed by Foster et al in 2011.[3] They did not differentiate between cervical, thoracic, and lumbar spine. The underlined components are those that are additional to the adult examination. The italicised components are those that the doctor should be aware of but not necessarily competent in.

With the patient standing:

  • Look at the spine from the side and from behind
  • Look at the skin and natal cleft
  • Look at limb and trunk proportions
  • Look at the face and jaw profile
  • Feel the spinal processes and paraspinal muscles and Temporomandibular joints (TMJs)
  • Assess movement: lumbar flexion and extension and lateral flexion; cervical flexion, extension, rotation and lateral flexion, thoracic rotation
  • Assess TMJ opening 
  • Options – Schober’s test, “stork test”

With the patient sitting on couch (standing in younger child):

  • Assess thoracic rotation

With the patient lying on couch:

  • Perform straight leg raising and dorsi-flexion of the big toe
  • Assess limb reflexes
  • Option – leg length, hypermobility, sacroiliac joint palpation (Faber’s / Patrick’s test)

References

  1. ↑ Esene et al.. Diagnostic performance of the medial hamstring reflex in L5 radiculopathy. Surgical neurology international 2012. 3:104. PMID: 23087820. DOI. Full Text.
  2. ↑ Nitta et al.. Study on dermatomes by means of selective lumbar spinal nerve block. Spine 1993. 18:1782-6. PMID: 8235861. DOI.
  3. ↑ Foster et al.. Pediatric regional examination of the musculoskeletal system: a practice- and consensus-based approach. Arthritis care & research 2011. 63:1503-10. PMID: 21954040. DOI.
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