Back & Neurological Back & Neurological ExaminationExamination

Dr Munir Saadeddin FRCSedDr Munir Saadeddin FRCSed

Back & Neurological examinationBack & Neurological examinationWhich Patients?Which Patients?

Back Pain (- or +Leg Pain)Back Pain (- or +Leg Pain)

Back DeformityBack Deformity

Neurological symptoms of lower limbNeurological symptoms of lower limb

Back InjuryBack Injury

Back & Neurological Back & Neurological ExaminationExamination

HistoryHistory

Examination whilst standing out of bedExamination whilst standing out of bed

Gait observationGait observation

Examination in supine positionExamination in supine position

Examination in prone positionExamination in prone position

Patient presenting & Back & Leg Patient presenting & Back & Leg PainPain

Patient presenting with Patient presenting with deformitydeformity

Back Inspection (standing)Back Inspection (standing)

Back Inspection (Forward Back Inspection (Forward Flexion)Flexion)

Back Inspection (Forward Back Inspection (Forward Flexion)Flexion)

Back Inspection in LBPBack Inspection in LBP

Examination of forward Examination of forward flexionflexion

Examination of Lateral Examination of Lateral FlexionFlexion

Examination of Back Examination of Back ExtensionExtension

Examination of RotationExamination of Rotation

Standing on Heels

Standing on TiptoesStanding on Tiptoes

Back Examination in Supine Back Examination in Supine PositionPosition

Does not include back inspectionDoes not include back inspection

SLR and Lasague maneuver should be SLR and Lasague maneuver should be donedone

Test the Test the sensationsensation (Dermatomes) (Dermatomes)

Test Test muscle muscle power (Mainly power (Mainly EHLEHL))

Test Test ReflexesReflexes

SLR : Straight Leg Raising SLR : Straight Leg Raising Test Test

SLR: 0-80 degreesSLR: 0-80 degrees

Lasague ManeuverLasague Maneuver

Sensory Testing : Sensory Testing : DermatomesDermatomes

Sensory Testing : Sensory Testing : DermatomesDermatomes

Clinical Picture L4 Root LesionClinical Picture L4 Root Lesion

L4 Neurological SignsL4 Neurological Signs

Clinical Picture : L5 Root Clinical Picture : L5 Root LesionLesion

L 5 Neurological SignsL 5 Neurological Signs

S 1 Neurologic LevelS 1 Neurologic Level

Clinical Picture : S 1 Root Clinical Picture : S 1 Root LesionLesion

L4 & L5 LesionsL4 & L5 Lesions

L5 & S1 LesionsL5 & S1 Lesions

Investigations in Back Investigations in Back ExaminationExamination

Plain X rays: AP, Lateral, Oblique, Cone Plain X rays: AP, Lateral, Oblique, Cone View &TomogramsView &Tomograms

Blood Tests: CBC, ESR, Bone Blood Tests: CBC, ESR, Bone BiochemistryBiochemistry

Ct scanCt scanMyelogram, RadiculogramMyelogram, RadiculogramMRIMRIBiopsy (CT guided or Cannulated trocar Biopsy (CT guided or Cannulated trocar

under fluoroscopy) under fluoroscopy)

Plain X Ray : AP & LateralPlain X Ray : AP & Lateral

Plain X Ray : Oblique 45 Plain X Ray : Oblique 45 degreesdegrees

Terry Dog & Scotty Dog Terry Dog & Scotty Dog appearanceappearance

Scotty dog appearanceScotty dog appearance

Myelogram & radiculogramMyelogram & radiculogram

Radiculogram Left L5 Root Radiculogram Left L5 Root CompressionCompression

C T Scan :C T Scan :(Spondylo(Spondylolysislysis)=Defect in Pars )=Defect in Pars

InterarticularisInterarticularis

C T : Intervertebral Disc C T : Intervertebral Disc ProtrusionProtrusion

CT MyelogramCT Myelogram

MRI Lumbar SpineMRI Lumbar Spine

Isotope Bone Scan (Tc99m)Isotope Bone Scan (Tc99m)

Closed Vertebral BiopsyClosed Vertebral Biopsy

Closed vertebral biopsyClosed vertebral biopsy

Closed Vertebral biopsyClosed Vertebral biopsy

Muscle Power EvaluationMuscle Power Evaluation

Certain muscles at lower or upper Certain muscles at lower or upper limbslimbs

We test Muscle Power We test Muscle Power NOTNOT range of range of joint movements!joint movements!

We give result by 0 - 5We give result by 0 - 5

Hip Flexion : Iliopsoas MuscleHip Flexion : Iliopsoas Muscle

Iliopsoas Muscle power TestIliopsoas Muscle power Test

Hip Adductor muscles( Obturator Hip Adductor muscles( Obturator N)N)

Hip Adductors TestHip Adductors Test

Quadriceps Muscle (Femoral Quadriceps Muscle (Femoral Nerve)Nerve)

Quadriceps Muscle TestQuadriceps Muscle Test

Tibialis Anterior TestTibialis Anterior Test

Psychological Aspects in Back Psychological Aspects in Back ExamExam