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