Osce Station - Back

7/24/2019 Osce Station - Back

1/7

August 2004

OSCE Station1

Back Examination

Back pain and sciatica: GP Registrar Brieing S!eet

The patient is a 28 year old dentist. (S)he is complaining of back pain andwhat (s)he believes may be sciatica.

The history is that this spring (s)he has been doing lots of work in her/his newgarden inclding creating a pond. !ith each day of gardening (s)he hasfond that her/his back has ached increasingly in the evening.

"ast weekend after going ot on her/his bicycle (s)he developed verynpleasant pain in her/his left posterior thigh.

!hen asked (s)he will say that her/his pain is increased by sitting and (s)hewill be relctant to sit when invited into the conslting room. #$%d rather stand&(S)he will say that driving and sitting on the toilet are e'crciatingly painfl.(S)he is reasonably comfortable standing and lying down the latterpreferably on her/his front.

(S)he also has some pins and needles on the lateral border of his left foot.

"!e task is to undertake an examination o t!e patient#s $um%ar spine&


2/7

August 2004

OSCE Station 1

Back Examination

BAC' PA() A)* SC(A"(CA: PA"(E)" BR(E+()G

o are a 28 year old dentist complaining of back pain and what yo believemay be sciatica.

The history is that this spring yo have been doing lots of work in yor newgarden inclding creating a pond. !ith each day of gardening yo fondthat yor back has ached increasingly in the evening.

"ast weekend after going ot on yor bicycle yo developed very npleasantpain in yor left posterior thigh.

!hen asked yo will say that his pain is increased by sitting and yo arerelctant to sit when invited into the conslting room. #$%d rather stand& o willsay that driving and sitting on the toilet have been e'crciatingly painfl. oare reasonably comfortable standing and lying down the latter preferably onyor front.

o also have some pins and needles on the lateral border of the left foot.

"!e doctor#s task is to undertake an examination o ,our $um%ar spine&

The e'amination findings are left straight leg raising limited to appro'imately*cm by pain in the thigh and some redced sensation on the lateral border ofthe left foot.$f his back is palpated he will complain of soreness on pressre over ".+is spinal movements are only slightly restricted in forward fle'ion beingable to reach mid shin with his finger tips again he will indicate somesoreness arond " and " posterior thigh pain, slmp test if performed will be e'crciatingly painfl on the left and he willdisplay some relctance to perform the test.

o may need to practice with the assessor.


3/7

August 2004 ASSESSORS ()S"R-C"(O) S.EE"

OSCE Station 1BAC' E/A()A"(O)

ou i$$ need a 3o$unteer patient !o is prepared to !a3e t!eir $um%arspine examined: see !andout&

There is no need for the - egistrar to take a history. The - egistrar isasked to ndertake an e'amination of the lmbar spine. o may need to briefthe patient to demonstrate the relevant findings. $t is not appropriate to allowthe - egistrar to ndertake a test for saddle anaesthesia for reasons ofdignity.

01ipment re1ired

0'amination 3och4 tape measre4 pin or monofilament for testing sensation4seat for slmp test4 tendon hammer.

The handot is also the assessment and feedback sheet for the - egistrar

C!eck$ist or marking

O%ser3ationostre es/no/partial

-eneral comment on mobility es/no/partial5isible deformity es/no/partial

Acti3e mo3ement6le'ion es/no/partial0'tension es/no/partialSide fle'ion es/no/partialotation es/no/partialSlmp test es/no/partialS" es/no/partialassive knee bend es/no/partial

Pa$pation

(nteraction it! t!e patient3onsiderate of symptoms es/no/partial3onfidence es/no/partial0'planation of techni1e and findings es/no/partial

An, comments


4/7

.andout

Examination o t!e 5um%ar Spine

$f the patient complains of leg symptoms refer to the dermatome section to give areasonable assmption at which level the lesion is4 i.e. lateral calfnmbness/7/pain9" nerve root. (+owever remember a high lesion can affectlower nerve roots:).

Su%6ecti3e ExaminationThe lmbar spine normally gives pain dring prolonged sitting4 lifting and stooping.-enerally pain pon walking tends to originate from the hip4 spinal stenosis orcirclatory disorders. 6or ob;ective markers se fnctional levels to assessimprovement i.e.4 time to dress4 sit etc withot pain.

0'amination ndertaken satisfactorily es/o/incomplete

O%6ecti3e Examination"eg length discrepancies are best ;dgedin standing se different si


5/7


3heck

3orrect pelvic tilting rhythm


Side 6le'ion

=easre hand to knee distance

0'amination ndertaken satisfactorilyes/o/incomplete

3heck>ality of each segmental movement


0'tension?ften restricted bt sometimes relieves symptoms.


otation@est measred in sitting to eliminate"eg/+ip rotation.


6/7


3heck,symmetry0'amination ndertaken satisfactorilyes/o/incomplete

Slmp TestThis is 1ite an aggressive test to check nerallength. roblems driving are often reprodced.


3heck-ood to affected. ,dd in ankle dorsifle'ion and

knee e'tension slowly. 3ompare this test to S"i.e.. $f slmp test negative bt S" A* deg positive::


S"

=easre heel to plinth with knee locked ine'tension and ankle plantargrade.


assive Bnee @endTo check femoral nerve length. ,dd in foot

movements to reprodce the patient%spain.



7/7

6inally4 palpate to pin point the local lesion start lightly


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Osce Station - Back