SPINE. Postural Malalignments 4/9/2015. Cervical Spine Evaluation. Thoracic Spine Evaluation. Observations. Assess position of head and neck

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1 SPINE Observations Body type Postural alignments and asymmetries should be observed from all views Assess height differences between anatomical landmarks Figure 25-9 Figure Figure & 12 Postural Malalignments Figure Cervical Spine Evaluation Assess position of head and neck Symmetry of shoulders (levels) Will the patient move the head and neck freely? Assess active, passive and resisted ROM Thoracic Spine Evaluation Pain in upper back and scapular region Cervical disk or trigger points (long thoracic nerve or suprascapular nerve involvement) Lower thoracic region pain Facet joint involvement W/ deep inspiration and chin tucked to chest Figure

2 Lumbar Spine and Sacroiliac Joint Observations Coordinated movement of the low back involves the pelvis, lumbar spine and sacrum Equal levels (shoulders and hip) Symmetrical soft tissue structures bilaterally Observe patient seated, standing, supine, side-lying, and prone (leg position - contractures) Palpation Spinous processes Spaces between processes - ligamentous or disk related tissue Transverse processes Sacrum and sacroiliac joint Abdominal musculature and spinal musculature Assessing for referred pain Have patient perform partial sit-up to determine tone and symmetry Assess hip musculature and bony landmarks as well Special Tests - Cervical Spine Cervical Compression and Spurling s Test Compression of cervical spine compresses facets and spinal roots Level of pain determines specific nerve root impingement Spurling s adds a rotational component to the cervical compression Adson s Test Tests for Thoracic Outlet Compression Syndrome Also known as Anterior Scalene Syndrome Test Purpose is to determine is the subclavian artery is being compressed Seated with one hand on thigh; radial pulse is taken Extend arm with patient elevates the chin & turns face towards extended hand Positive: pulse is depressed or stopped Figure & 18 Adson s Allen s Test Tests for Thoracic Outlet Compression Syndrome Hyperabduction Syndrome Test Seated; radial pulse is taken with the elbow is flexed to 90 and the shoulder is extended horizontally and rotated laterally Head is rotated away from the injury. 2

3 Allen Tests Done in Standing Position Forward bending Observe movement of PSIS, test posterior spinal ligaments Backward bending Anterior ligaments of the spine Disk problem Lesion of pars interarticularis opposite side of raised leg when doing single-leg (stork) standing position Side bending Lumbar lesion or sacroiliac dysfunction Tests Done Standing (continued) Standing Trunk Rotation Assessment of symmetrical motions w/out pelvic movement All tests allow for symmetry and landmark assessment Figure Figure & 22 Test Done in Sitting Position Forward bending - PSIS motions and restrictions Trunk Rotation - lumbar spine motion symmetry Hip Rotation - IR and ER to assess integrity and status of the piriformis muscle Slump Test Monitor changes in pain as sequential changes in posture occur 1. Cervical spine flexion 2. Knee extension 3. Ankle dorsiflexion 4. Neck flexion released 5. Both legs extended Assessment of neural tension Figure Tests Done in Supine Position Straight Leg Raise 0-30 degrees = hip problem or nerve inflammation degrees= sciatic nerve involvement W/ ankle dorsiflexion = nerve root degrees = sacroiliac joint pathology 3

4 Well Straight Leg Raising Test Performed on the unaffected side, may produce pain in the low back on the affected side and cause radiating pain in the sciatic nerve Positive test indicative of nerve root inflammation or disk herniation Milgram and Hoover Straight Leg Raising Test Milgram test: hold both legs for 30 seconds off table; increases intrathecal pressure causing disk to put pressure on lumbar nerve root The Hoover test: cup calcaneus & have lift leg on involved side; (+) no attempt to lift & no sense of any pressure on uninvolved side = malingering Figure Figure & 30 Bowstring test Used to determine sciatic nerve involvement Leg (on affected side) is lifted until pain is felt Knee is flexed to relieve pressure and popliteal fossa is palpated to elicit pain (along sciatic nerve) To verify problem w/ nerve root, leg is lowered, ankle is dorsiflexed and neck is flexed. Return of pain verifies nerve root pathology FABER and FADIR tests FABER or Patrick s test is used to assess anterior hip pathology or SI joint dysfunction FADIR is used to assess pathology of the lumbar spine with a positive test being increases in the low back pain FABER Figure FADIR Knee to Chest Bilateral - increases symptoms to lumbar spine Single - pain in posterolateral thigh may indicate problem with sacrotuberous ligament Pulling knee to opposite shoulder that produces pain in the PSIS region may indicate sacroiliac ligament irritation SI Compression and Distraction Tests Used for pathologies involving SI joint Beevor s Sign Patient does a quarter sit-up with arms crossed on shoulders Patient holds the position & observe the umbilicus Normally = not move at all Any movement = asymmetrical involvement of the anterior abdominal & paraspinal muscles Drawn to the stronger or uninvolved side Figure & 34 4

5 EVALUATION Observation ROM: active, passive, resistance Grip Strength Compression test Valsalva test Adson/ Allen Observation ROM: active, passive, resistance SLR Well SLR Hoover Milgram FABER/FADIR Beevor SI Distraction/Compression 5

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