as well as the spine surgeon with the Rocky Mountain Scoliosis and Spine Clinic

on the campus of Presbyterian/St. Luke's Medical Center

I'm here today to speak about physical examination procedures

physical therapists can use in determining whether

to refer a patient to the spine specialist these procedures can be

broken down into

eight categories posture range of motion

skin gait motor strength sensory conditions

reflexes and a range of motion of the extremities

in assessing posture we look for normal lordosis

C1 through C7 to be approximately 20 to 40 degrees

any condition of torticollis commonly known as wry neck

should be noted in the thoracolumbar region

normal kyphosis should be between T5 and T7

and again should be roughly between 20 and 40 degrees

and lordosis the lumbar spine should be approximately forty to sixty degrees

we also look for any real prominence including

gibbus deforminty on Adam's Forward Bend

as well as vertebral rotation and also check the spine with a scoliometer

for

thoracic or lumbar prominences flat back deformity

or a loss of normal lordosis in the lumbar spine

is also a potential indicator of problems next we perform test

on the range of motion the spine in the extremities

from the cervical region we test for Spurling's

or creation of extremity pain by extending the neck

and rotating the chin toward the affected extremity this is an indicator of nerve

root compression

and we also ascertain any sternocleidomastiod or

trapizus pain including any soft tissue or bony anomalies

then turning to the thoracolumbar region we check for flexion pain

which is an indicator disc with their problems as was extension pain

which may show us vacepulator problems after checking for range in

motion the lumbar spine

we then turn to evaluation and the skin scars

can the notes problems including previous surgery as well as previous

trauma

hairy patches and skin dimpling may also indicate

underlying bony or neurologic anomalies

a simple gait analysis can also uncover a spinal condition namely

is their gait unsteady this may be due to pain

or cervical stenosis turned over gait

or a side to side lurch type gait is due to weakness

of the gluteus medius and gluteus minimus motor strength is a good indicator of

spinal problems

motor strength is graded I'm a scale of 0 to 5

with 0 being no evidence of contractivity of

the motor fibers and five being

normal strength in that muscle distribution

the cervical and lumbar dermatomes are useful

in assessing and locating a corresponding

nerve root that maybe compressed

or affected reflexes are tested next

and they are graded on a scale from 0 to 4 plus

zero indicates a absence of the reflex 2

indicates a normal reflex and four plus indicates hyperactivity

with associated clonus of the lower extremities again the reflexes

follow a normal dermatome that corresponds

to that respective nerve root. In addition

to testing the reflexes of the lower extremeties

we also test the reflexes around the umbilicus region

we want to do a stroke all four quadrants

that's surround the abdomen and correspondingly

the umbilicus should move toward the stimulus

or the area that is being tested a lack

over a reflex or pull away from the region that is being stroked or

tested indicates an upper motor neuron lesion

and should then be investigated via

advanced imaging next the Hoffman test

is performed by striking either the volar or

or dorsal aspects of the middle finger

and observing the reflex contraction of the thumb or

index finger a positive hoffman's reflex

indicates presence of a upper motor neuron lesion

most likely emanating from spinal cord compression we next

test the planter aspects of the foot evaluating for a Babinski sign

normally when stroking the bottom or plantar aspect

the foot the toes will flex down

however in the case of a positive Babinski sign

the toes splay upgoing rather than down going

up going toes or a positive

Babinski sign indicates a potential

upper motor neuron lesion lastly we test

ankle clonus which case tension

on the Achilles ligament will cause a

rhythmic contraction causing the foot to alternate between

dorsiflexion and plantar flexion again

this most commonly indicates an upper motor neuron lesion

next we test for nerve tension signs

in performing a straight leg raise if raising away

and dorsiflexing the foot causes pain that radiates from the back

into the leg indicates there is a space

occupying lesion impacting the disc

which most commonly is caused by a herniated lumbar

disc in the event there is a contra lateral straight leg raise

namely by raising the right leg

causes left leg pain it's indicative of severe compression

above the contra lateral nerve root

cervical nerve tension is tested by the Spurling sign

or creation above upper extremity pain

by extending the neck and rotating the chin

toward the affected extremity this will then cause

nerve root pain in that involve extremity

if them by placing the ipsilateral hand onto the head

and turning the head to the contralateral shoulder this relieves the pain

this again indicates that the nerve is being compressed

and then we turn the head go away from the nerve root

which relieves decompression pain

carpal tunnel or median nerve compression at the wrist

and cubital tunnel or ulnar nerve compression

at elbow are assessed with Falen's

Tinel's at the wrist and elbow

osteo-arthritis of the hip is evaluated by

internal rotation of the hip if groin pain is present

then hip osteoarthritis is indicated with internal rotation of the hip

osteoarthritis of the knee is evaluated for joint line tenderness

at the knee lastly a vascular examination is performed by

evaluating for the Dorsalis pedis and posterior tibial pulses

these are graded from range from 0 to

2 zero indicates absence of a pulse

one indicates be diminished but palpable pulse and two

indicates a normal pulse also as part of the vascular examination

a visual examination should note for hair loss

shiny skin edema or toenail changes

all over which are indicative vascular insufficiency

spinal conditions are serious proper assessments critical

we encourage you to follow this protocol for assessing spinal conditions

in your patients

in