Spine examination

2021-01-26 12:00 AM

The spinal cord contains the spinal cord, central nervous system, in the spinal canal and produces nerve roots through the junction to control the body's activities.

Recall surgery

The spine consists of 32 vertebrae connected together to form the axis of the body. The main components of the vertebra include:

Vertebral body.

Table lives.

The spikes, the joints.

The bow (stalk).

Live disc (disc)

To maintain the spine there is a system of ligaments

Front vertical wire.

Vertical wire back.

Gold ligament.

Inter-thorn ligament. 

The spinal cord contains the spinal cord (central nervous system) in the spinal canal and produces nerve roots (peripheral nerves) through the junction to control the body's activities (sensation, movement, reflex ... In the lower vertebrae the spinal cord is not located at the same end as the vertebra of the same name.

The spine is divided into 4 segments

Neck (cervical: C).

Chest and back (Thoracic: T; Dorsal: D).

Belts (Lumbar: L).

Same (Sacrum: S) and coccyx (Coccy: Co).

The movements of the spine include

Bow (front fold).

Back.

Turn.

Side bend (tilt).

Injuries to fracture the spine are more common in the neck and chest - lumbar.

Physical examination and x-ray of the spine

The spinal examination should be done according to the principle

In a certain order: Look, touch, knock, move the spine.

Physical examination of the spine.

Neurological examination.

X-ray examination of the spine.

Physical examination of the spine:

Look:

Determination of spinal axis: is the straight line connecting the posterior spines from C1 - between the buttock folds.

Evaluate the balance of the pelvis: connect 2 upper anterior pelvic spines, 2 upper posterior pelvic spines, normally 2 straight lines.

Evaluate the balance of 2 roles. When scoliosis is decompensated, the shoulders will skew.

Skewed view: Surveying the curve of the spine, detecting the hunchback of the spine.

Touch:

Locate the vertebrae.

Detect live deformations, tumours.

You can see that the muscle mass next to the living spasm. 

Type: vertical spines to find pain.

Campaign examination:

Sliver movement.

Stretching movements of the chest

Tilt movements.

Swing movement. 

Palpation:

Press along live spines or use a hammer to reflexively strike live spines: normally painless. 

Typing:

Head-down punching creates force that is transmitted along the spine or for the patient to stand on tiptoes and pound heels hard on the floor. Usually no pain. 

Motor:

There are 3 pairs of movement:

Bow - back.

Rotate (left) - rotate (right).

Fold left (left) - side fold (right).

Normal indicators:

Cervical spine:

Neck bow: Chin touches breast (about 45 0 ).

neck tilt: Eyes straight at the ceiling (about 45 0 ).

Side bend (tilt): Ear - shoulder (about 45 - 60 0 ).

Rotate (left) - rotate (right): 45 0 .

Spine - lumbar:

Bow: Your fingertips touch the ground or a few centimeters (about 90 degrees) from the ground. The shape of the spine is harmonious (in the inflammation of the spine, the spine is straight). Both halves of the thorax are evenly curved (in scoliosis the two halves structure is disproportionate)

Side bend (left and right tilt): Both hands hold the crest for the pelvis upright, tilt the patient to the left and right. Normally, each side is about 30 - 45o

Rotate: Hold the pelvis as above and have the client rotate left and right. Normally, each side is about 30 - 45 0 .

Examination of the spine in a lying position:

Tummy:

Place the patient on his or her stomach neatly on a flat bed, face down.

Check for bone markers and examination criteria in an upright position.

Redefine the spinal axis (some diseases in the lower extremities deviate the scoliosis when the patient stands, but it will go away when the patient is lying down).

Find sore spots on the spine.

Touch the muscles next to the spine, swipe along these muscles, normally the muscles are soft, painless, the skin is not red (when there are nutritional disorders, these muscles contract, the skin rashes under the fingers when stroking)

Press the hip joint and look for pain points along the path of the sciatica (enlarged hip nerve). Usually no pain.

Lay up:

Place the patient on his or her back neatly on a flat bed. Normal spine decreases physiological curvature. Unable to put the hand below the patient's waist (when the spine is too extended, the hand will be placed below the waist).

Attention:

Patients with spinal injuries are examined only in a lying position. The examiner must use his hand to thread the patient's back to find the pain, hunchback ...

Solutions.

Measuring the Schober Index:

Patient is upright, marking the center of the spine L4, L5, measuring up to a 10 cm segment, marked.

Have the patient bow as much as possible and re-measure the distance above. Normal has a difference of 4 - 5 cm (in ankylosing spondylitis this difference is <2 cm)

Lasegue test (straight leg raising test).

Patient lies on his back on a flat bed, legs stretched, and his ankles are neutral.

The one-hand examiner holds the patient's ankle and gradually raises the lower limb (passive groin folding, the other hand is placed in front of the pillow in a straightened position. Usually no pain.

If the groin fold is less than 60 degrees positive, the patient feels sharp pain from the hips, buttocks, and the back of the thigh. This sign is seen in some diseases of sciatica, lumbar disc herniation, inflammation of the spine joints, pelvic arthritis and tendon of the muscles behind the thigh.

Neurological examination:

Campaign examination:

Remember the milestones that govern the movement:

Pelvic folding: marrow and roots at L1 and L2.

Pillow folding: L5 - S1.

Stretching pillow: L3 - L4.

Mechanical power rating according to the table:

Point

Level

0

No muscle contraction

first

Muscle contraction does not arise

2

Muscle contraction wins chi weight

3

Muscle contraction cannot win resistance

4

Muscle contraction

5

Exercise normally.

 Sensory examination:

Use a sharp object to examine the pain, the stone to examine the sensation of heat and cold.

Sensory landmarks to remember:

Breast: T4

Umbilical line: T 10

Pot: T 12

Mid-thigh: L2

Outer shank: L5

Foot outside: S1

Classification of nerve damage according to Frankel (1969):

Species

Function

A

Complete loss of sensation and movement below the level of damage.

B

As for feeling, loss of movement

C

As for the feeling, the chi power reaches 2/5

D

As for feeling, the chi power reaches 3/5; 4/5

E

Movement and feeling normal.

 Reflection examination:

Cave reflexes.

Sphincter reflex.

Tendon reflex. 

Myelosuppression: depending on the location of damaged marrow, the clinical manifestations are different.

Central medullary syndrome: bilateral uniform paralysis.

Anterior medullary syndrome: damage to the anterior spinal horn. Patients with motor paralysis but still feeling.

Posterior medullary syndrome: movement but loss of sensation.

Horsetail syndrome: disorders of the round and sensation muscles.

X-ray examination:

Conventional x-ray: Evaluate on straight and tilted film, determine: survey physiological curve of spine, spine, location of vertebral injury, vertebrae height, longitudinal axis of spine, location of lesion lesions of the vertebra, height of the vertebrae, the longitudinal axis of the spine, dislocation of the vertebra, rupture of the components of the vertebra, scoliosis.

Contrast radiography: Evaluation of pulp and nerve root compression.

Computer tomography: accurately assessing bone damage.

Nuclear magnetic resonance imaging: Accurately assess soft tissue and marrow injury.