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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)

perineum and perianal region


inguinal region S2, S3, and S4).
(T12, L1)

Dermatomal (sensory) distribution


Special tests
• SLR
• Femoral stretch test
• SPINAL (PRIMITIVE REFLEXES)
• Hip flexion MOTOR FUNCTION
 L2
• Knee extension
 L3
• Ankle extension
 L4
• Toe extension
 L5
• Ankle flexion
 S1
• Ankle eversion
 S1
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