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