Back History and Physical Exam

History

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Inspection

Inspect C spine lordosis, thoracic kyphosis, lumbo lordosis

Birthmarks, port-wine stains, hairy patches, and lipomas can overlie bony defects such as spina bifida.

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Palpation

Spinous processes (C7 is prominent one on back).

Sacroiliac joint: can be caused by ankylosing spondylitis

Pain on percussion can be caused by osteoporosis, infection, or malignancy.

 

The sciatic nerve lies midway between the greater trochanter and the ischial tuberosity. Tenderness suggests herniated disc or mass pushing on the contributing roots.

 

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Range of Motion

C spine

Rest of spine

 

Flexion/extension: not range of motion, smoothness and symmetry, and lumbar curve. A persisting lumbar curve can be seen with muscle spasm or in ankylosing spondylitis.

Rotation (have patient seated to aviod hip swivels): have the patient place their hands on their hips to better observe rotation.

 

Lateral bending

 

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Special Tests

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