Examination Of The Trunk.www.1aim.net

EXAMINATION OF THE TRUNK

PAIN • • • • • • •

What caused the pain? (acute or chronic) Where is the pain? Radiation? (to & from) Character Abnormal sensation Exacerbation and relief? Course (progressive, regressive , stationary)

IMPORTANT POINTS • Patients occupation • Faulty postural habits? • Abnormal gait? • Medications? • Sphincter & sex abnormalities

PAST HISTORY - SYSTEMIC DISEASE - MEDICATION - SURGERY FAMILY HISTORY

Examination of the Dorso lumbar Spine

Patient examined standing

LOSS OF LUMBAR LORDOSIS

LIST

SCOLIOSIS

Attitude:

• + PAIN • • •

Sciatic list. Decreased lumbar lordosis. Scoliosis.

.”bending forward test“

Active Spine movements • Forward flexion (to 90) • (Extension (20-35⁰) • side flexion (15-20⁰) • Rotation (3-20⁰)

Walking on heels (L4,5)

Walking on toes (S1)

Palpation Posterior: • spinous processes, facets, sacrum coccyx, iliac crest, ischial tuberosity and sciatic nerve Anterior: • abdomen organs, aorta, inguinal area, iliac crest, symphysis Prone position Hip extension  S1 Knee flexion  S1 & S2

ABRASIONS,CONTUSIONS KYPHUS

Dermatomes (L1 (L4 • L1 back of trochanter • • •

and groin L2  front of thigh knee, back of iliac crest L3 upper buttock, front of thigh, & knee & medial lower leg L4  inner buttock, outer thigh, inside of leg, dorsum of foot & great toe

Dermatomes (L5 (S4 • L5  buttock, lat. Aspect of leg • • • •

& dorsum of foot, inner sole & first three toes S1  buttock, back of thigh and leg S2  same as S1 S3  groin, inner thigh, perinium S4 & S5  perineum genitals & lower sacrum

AUTONOMOUS SENSORY ZONES

nipple line (T4), xiphoid process (T7) Umbilicus (T10)

inguinal region (T12, L1)

perineum and perianal region S2, S3, and S4).

Dermatomal (sensory) distribution

Special tests

• SLR • Femoral stretch test • SPINAL (PRIMITIVE REFLEXES)

• Hip flexion • • • • •

 L2 Knee extension  L3 Ankle extension  L4 Toe extension  L5 Ankle flexion  S1 Ankle eversion  S1

MOTOR FUNCTION

Reflexes • • • •

Knee  L3 Ankle  S1 Medial hamstrings L5 Lateral hamstring  S1

PRIMITIVE (spinal) REFLEXES

Anus

Glans

Babiniski test

Bulbo-cavernosus test

Lumber Root Syndromes Root pain Dermatome Muscle weakness Reflexes abn. Sensory examination.

Special tests Malingerer patient

PLAIN X-RAY

CT

D CT 3

MRI

BONE SCAN