Quick Review: Examination of the Neck, Back, and Hip

by Stephen Holt, MD, MS

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    00:01 So let's review the content that we've just covered for the musculoskeletal exam.

    00:06 We'll cover just a few specific points as we go through this chart.

    00:10 So patients with scoliosis, the best way to detect it is to have the patient forward flexion.

    00:15 And just look at whether or not the paraspinal musculature is even on both sides.

    00:22 Muscle strains.

    00:23 If you have a left-sided muscle strain, then leaning away from that muscle strain or tilting your head away from that muscle strain should exacerbate their pain.

    00:32 Patients with a compression fracture, whether it's osteoporotic or traumatic, you expect to have point tenderness over that specific vertebrae.

    00:41 That spine is process of the vertebrae involved.

    00:44 Ankylosing spondylitis.

    00:45 You remember you do that test called the Schober test, we're going to mark 10 centimeter stretch of the spine around the lumbar area and have the patient lean forward looking to see if their spine is too straight and does not flex appropriately.

    01:01 Uncomplicated spondylosis.

    01:03 Just essentially, osteoarthritis of the facets around the vertebrae, you'd expect such patients to have pain as you lean towards the affected side, bringing those facets that are diseased closer in approximation versus complicated spondylosis that is spondylosis with radiculopathy or myelopathy we're going to be looking for abnormalities on the neuromuscular exam, whether upper motor neuron or lower motor neuron finding.

    01:32 So which of the following suggests left-sided lumbosacral muscle strain? Is it a positive Schober test? Positive sacral compression test, paresthesias over the anterolateral thigh, left-sided pain with rightward lateral flexion or left sided pain with leftward lateral flexion.

    01:57 Well, from our test taking skills, you can probably guess it's going to be either D or E.

    02:01 But let's take a look at A, B, and C first.

    02:03 So a positive Schober test is going to go along with ankylosing spondylitis.

    02:09 Positive sacral compression test would accompany patients with sacroiliitis of whatever etiology.

    02:15 Paresthesia is over the anterolateral thigh is a descriptor for meralgia paresthetica or entrapment of the lateral femoral cutaneous nerve.

    02:24 And then, if a patient has left-sided lumbosacral muscle strain, leaning away from the lesion towards the right should exacerbate that discomfort.

    02:34 So the answer is D.

    About the Lecture

    The lecture Quick Review: Examination of the Neck, Back, and Hip by Stephen Holt, MD, MS is from the course Examinations of the Neck and Back Region.

    Author of lecture Quick Review: Examination of the Neck, Back, and Hip

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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