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Waleed Awwad, MD, FRCSC
Waleed Awwad, MD, FRCSC
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Column
Anatomy• Spinal Cord
Anatomy• Spinal Cord
Physical exam
•Inspection.•Gait.•Palpation.•Range of motion.•Manipulation ( Neurologic Ex ).
•Special tests.
•Inspection.•Gait.•Palpation.•Range of motion.•Manipulation ( Neurologic Ex ).
•Special tests.
inspection•Surface anatomy and alignment
•Coronal and sagittal alignment•Shoulder level•Thoracic hump•Waist symmetry•Pelvic obliquity•Skin lesions
•Surface anatomy and alignment
•Coronal and sagittal alignment•Shoulder level•Thoracic hump•Waist symmetry•Pelvic obliquity•Skin lesions
gait
•Shuffling and slap foot gait•Broad-based gait•Antalgic gait
•Shuffling and slap foot gait•Broad-based gait•Antalgic gait
palpation
•Spinous process for tenderness or step
•Musculature for spasm
•Spinous process for tenderness or step
•Musculature for spasm
Range of Motion
•Cervical spine•Thoracic spine Flexion and extension, Modified Schober test and
chest expansion.
•Lumber spine
•Cervical spine•Thoracic spine Flexion and extension, Modified Schober test and
chest expansion.
•Lumber spine
Neurologic
•Muscle Test•Sensory exam light touch, Sharp dull discrimination, Vibration sense,
Proprioception and two-point discrimination
•Reflexes
•Muscle Test•Sensory exam light touch, Sharp dull discrimination, Vibration sense,
Proprioception and two-point discrimination
•Reflexes
NeurologicSensory 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
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
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
• 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
Neurologic
•Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex
Abdominal reflexes Knee, ankle, planter reflex
•Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex
Abdominal reflexes Knee, ankle, planter reflex
Special test
•Nerve Tension Tests Upper limb tension test
Lower limb tension test Strait-leg raising test (SLRT) Crossed SLRT Lasegue’s test
Femoral nerve stretch test
•Nerve Tension Tests Upper limb tension test
Lower limb tension test Strait-leg raising test (SLRT) Crossed SLRT Lasegue’s test
Femoral nerve stretch test
Special test •Axial compression test•Spurling’s test•Nonorganic signs of Waddell Simulation test (axial compression, rotation
simulation) Non anatomic tendrness Distraction sign Regional sensory or motor disturbance Overreaction
•Axial compression test•Spurling’s test•Nonorganic signs of Waddell Simulation test (axial compression, rotation
simulation) Non anatomic tendrness Distraction sign Regional sensory or motor disturbance Overreaction
Thank you
