Cervical & Lumbar Exam

Question 1

Chief Complaints of the Cervical Spine

Answer 1

Posterior neck pain
Upper trap/shoulder pain
Pain between the shoulder blades
Weakness
Alterations in fine motor control
Numbness: specific or generalized
Ataxic gait

Question 2

Things to Observe of the Patient’s Movements & Actions

Answer 2

General appearance
Abnormal pain behaviors
Mood & affect
Gait

Question 3

Inspection of the Cervical Spine

Answer 3

Skin

Posture

Question 4

Palpation of the Cervical Spine

Answer 4

Cervical point tenderness
Muscle spasms
Lymphadenopathy

Question 5

Range of Motion for the Cervical Spine

Answer 5

Flexion
Extension
Lateral bending
Rotation

Question 6

Sensory Testing Area for C5

Answer 6

Lateral upper arm

Question 7

Sensory Testing Area for C6

Answer 7

Lateral forearm

Question 8

Sensory Testing Area for C7

Answer 8

Middle finger

Question 9

Sensory Testing Area for C8

Answer 9

Ulnar border of the hand

Question 10

Sensory Testing Area for T1

Answer 10

Medial upper arm

Question 11

Grades of Muscle Strength & Description

Answer 11

5/5: normal power
4/5: active movement against gravity with resistance
3/5: active movement against gravity
2/5: active movement without gravity
1/5: trace or flicker of movement
0/5: no movement

Question 12

Muscle Strength Testing of C5

Answer 12

Deltoids

Biceps

Question 13

Muscle Strength Testing of C6

Answer 13

Biceps

Wrist extension

Question 14

Muscle Strength Testing of C7

Answer 14

Wrist extension
Wrist flexors
Triceps
Finger extension

Question 15

Muscle Strength Testing of C8

Answer 15

Finger flexion

Question 16

Muscle Strength Testing of T1

Answer 16

Intrinsics (fanning fingers)

Question 17

Special Cervical Spine Tests

Answer 17

Axial loading
Foraminal compression test (Spurling’s)
Hoffman’s Reflex

Question 18

What is a positive Spurling’s sign?

Answer 18

Pain radiates to arm toward which head is side flexed

Question 19

Describe Hoffman’s Reflex

Answer 19

Have the hand relax
Flick the end of the middle finger
(+) other fingers may flex

Question 20

What does a positive Hoffman’s reflex reflect?

Answer 20

Presence of an upper motor neuron lesion from spinal cord compression

Question 21

Reflex for C5

Answer 21

Biceps

Question 22

Reflex for C6

Answer 22

Brachioradialis

Question 23

Reflex for C7

Answer 23

Triceps

Question 24

Reflex for C8

Answer 24

None

Question 25

Range of Motion of the Shoulder

Answer 25

``` Flexion Extension Abduction Internal rotation External rotation Across the chest ```

Question 26

Chief Complaints of Lumbar Vertebrae

Answer 26

``` Back pain Buttock pain Leg pain Weakness Numbness/tingling ```

Question 27

Inspection of the Lumbar Spine

Answer 27

Skin Muscle spasms Posture

Question 28

Palpation of the Lumbar Spine

Answer 28

Point tenderness Trochanteric tenderness SI joint pain

Question 29

Range of Motion of the Lumbar Spine

Answer 29

Flexion Extension Lateral bending Rotation

Question 30

Tests for Gait

Answer 30

Tip toe walking Heel walking Tandem gait (drunk driver test)

Question 31

Sensory Testing for L1

Answer 31

Groin

Question 32

Sensory Testing for L2

Answer 32

Midanterolateral thigh

Question 33

Sensory Testing for L3

Answer 33

Distal anteromedial thigh

Question 34

Sensory Testing for L4

Answer 34

Medial ankle

Question 35

Sensory Testing for L5

Answer 35

Dorsum of foot

Question 36

Sensory Testing for T1

Answer 36

Lateral border of foot

Question 37

Muscle Strength Testing for L1

Answer 37

Hip flexors

Question 38

Muscle Strength Testing for L2

Answer 38

Hip flexors Hip adductors Quadriceps

Question 39

Muscle Strength Testing for L3

Answer 39

Hip flexors Hip adductors Quadriceps

Question 40

Muscle Strength Testing for L4

Answer 40

Hip adductors Quadriceps Ankle inversion Hip abductors

Question 41

Muscle Strength Testing for L5

Answer 41

``` Ankle inversion Hip abductors EHL, toe extensors Ankle eversion Ankle plantar flexion ```

Question 42

Muscle Strength Testing for S1

Answer 42

Ankle eversion | Ankle plantar flexion

Question 43

Muscle Strength Testing for S2

Answer 43

Ankle eversion | Ankle plantar flexion

Question 44

Motor, Reflex & Sensory of L4

Answer 44

M: tibialis anterior (ankle dorsiflexion) R: patella tendon S: medial aspect of the foot

Question 45

Motor, Reflex & Sensory of L5

Answer 45

Extensor hallucis longus R: none S: dorsum of the foot

Question 46

Motor, Reflex & Sensory of S1

Answer 46

M: Peroneus longus & brevis (ankle eversion) S: Achilles tendon S: lateral aspect of the foot

Question 47

Special Tests for the Lumbar Spine

Answer 47

Babinski sign Ankle clonus Supine/sitting straight leg raise Femoral nerve stretch test

Question 48

What does a positive Babinski sign or ankle clonus reflect?

Answer 48

Presence of an upper motor neuron lesion from spinal cord compression

Question 49

Describe a Femoral Nerve Stretch Test

Answer 49

Patient lies prone with the knee passively flexed to the thigh

Question 50

What is considered a positive femoral nerve stretch test?

Answer 50

Anterior thigh pain

Question 51

Reflex for L4

Answer 51

Patellar tendon

Question 52

Reflex for S1

Answer 52

Achilles tendon

Question 53

Special Tests for SI Joint Irritation

Answer 53

Compression Distraction Faber's

Question 54

Describe Compression as an SI Joint Irritation Test

Answer 54

Patient lies with affected side up Hips at 45 degrees & knees at 90 degrees Downward pressure on the iliac crest

Question 55

Describe Distraction

Answer 55

Patient supine with examiner on affected side Examiner hands on ASIS with arms crossed Application of pressure downward & laterally

Question 56

Describe Faber's

Answer 56

Patient supine with examiner on affected side Leg of affected side bent with foot on opposite knee Downward & lateral pressure applied