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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