spine exam

Spinal examinations are usually combined with visual, tactile, and percussive examinations. The main contents include the curvature of the spine, the presence or absence of deformity, the mobility of the spine, and the presence or absence of tenderness and snoring. Whether the spine is in the middle, whether there is a scoliosis or not, and the upper body tends to the side. Scoliosis, should indicate the direction and location of the scoliosis C-shaped, anti-C-shaped, S-shaped or anti-S-shaped; whether the shoulders are equal, whether the top of the double sputum is horizontal. To the side of the upper body, the degree of displacement can be estimated from a straight line of the seventh cervical spine. Basic Information Specialist classification: growth and development check classification: physical examination Applicable gender: whether men and women apply fasting: not fasting Analysis results: Below normal: Activities are limited and require further inspection. Normal value: Neck flexion and extension: 45°- Left and right side bends: 60°- The lumbar segment is flexed and stretched under the condition of the buttocks: 45°- Waist section: 30°- Above normal: Activities are limited and require further inspection. negative: Positive: Tips: During pregnancy, certain protective measures should be taken to prevent the X-ray from affecting the fetus. Before the spine examination, the front side of the spine and the oblique position should be taken. Normal value There are four physiologically curved cervical vertebrae in the healthy adult spine; the thoracic spine is prominent; the lumbar vertebrae are prominently protruding; the atlas is posterior. The inspected should be subjected to flexion and extension, left and right side bending and rotational movement. The normal movement degree is 45° after the cervical flexion and 60° to the left and right side, and the lumbar segment is flexed under the condition of the buttocks. Stretch 45°, right left bend 30°, rotation 45° No abnormal pain during the examination. Clinical significance Abnormal result a) back view 1. Whether the spine is in the middle, whether there is a scoliosis or not, and the upper body tends to the side. Scoliosis, should indicate the direction and location of the scoliosis C-shaped, anti-C-shaped, S-shaped or anti-S-shaped; whether the shoulders are equal, whether the top of the double sputum is horizontal. To the side of the upper body, the degree of displacement can be estimated from a straight line of the seventh cervical spine. Scoliosis can be divided into 1 Postural scoliosis, seen in children with poor sitting posture, disc herniation, sequelae of poliomyelitis, etc. If the standing position has a side bend and disappears in the sitting position or lying position, it may be caused by the unequal length of the two lower limbs; 2 organic scoliosis, seen in rickets, chronic pleural thickening, pleural adhesions and shoulder deformities, changes in position can not make the scoliosis corrected. 2, the situation of the back muscles: the back muscles of both sides are flattened and the central spinous process is a bulge, which is prone to hunchback and low back ligament strain. In addition, it should be noted that the bilateral sacral spine muscles are symmetrical, with or without atrophy or spasm. Patients with low back pain, such as lumbar tuberculosis, acute sprains, etc., often have psoas muscle spasm. 3, automatic movement: the movement of the spine is mainly in the cervical vertebrae and lumbar vertebrae, its movement includes flexion and extension, left and right side flexion and left and right rotation. When examining the cervical vertebrae, the shoulders should be fixed so that the trunk does not participate in exercise. Check the thoracic vertebra activity, first fix the pelvis and then rotate the shoulder. The difference between deep exhalation and expiratory chest circumference is the degree of chest dilatation. The normal value is 5cm. If the chest dilatation disappears, it often indicates the abnormality between the posterior rib joint and the thoracic vertebra. More common in ankylosing spondylitis. (2) Side inspection 1. Kyphosis, the excessive curvature of the spine, occurs mostly in the thoracic segment, also known as the gibbus. During the examination, the chest collapses and the abdomen protrudes forward. There are many reasons for the kyphosis of the spine and the performance is not the same. For example, vertebral kyphosis in children is mostly caused by thoracic pyramidal tuberculosis. The lesion often occurs in the lower chest. Due to cone destruction, the spinous process is prominent backward, which is called angular deformity. The lower part of the thoracic segment and the lumbar segment of the adolescent are both kyphosis, mostly due to poor posture during development or suffering from spinal osteochondritis. Adult thoracic segments are curved (or arcuate) kyphosis, seen in ankylosing spondylitis, the spine is fixed, and the supine spine cannot be flattened. The kyphosis of the elderly occurs mostly in the upper part of the thoracic segment, which is caused by degeneration of the bone and compression of the thoracic cone. After a traumatic thoracic fracture, it can be the cause of kyphosis in any age group. 2, lordosis (lordosis) that is, the spine is excessively bent forward, occurs in the lumbar part, also known as the lumbar deformity, can be seen in physiological conditions such as pregnancy, but also due to massive ascites, spondylolisthesis, congenital dislocation of the hip or Inflammation caused by hip flexion deformity. The flexion and extension range of the spine and the central part of the activity when bending over can be observed on the side. When the lumbar flexion, the normal spine can be bent into a C shape, and the activity of the diseased spine is significantly reduced, and the main activity center is in the hip joint. (three) spinal tenderness and snoring pain Snoring can be checked in two ways Direct percussion: It is a direct attack on each spinous process by a hammer or a finger. In deep vertebral disorders such as tuberculosis or spondylitis, localized beatings, deep pain, and tenderness is not obvious or light. Indirect sniper method: the patient takes the seat, the doctor puts the palm of his left hand on the top of the patient's head, and the right hand half clenches the fist to slam the left hand to observe the patient's pain. The normal person has no spine and pain. If the spine has lesions, it can cause suffocation in the damaged area. Positive snoring pain can be seen in spinal tuberculosis, fractures and disc herniation. People who need to be examined: people with abnormal pain in the waist and abdomen. Low results may be diseases: pediatric spina bifida, young hunchback, spinous process tenderness, spinous process fracture, spinal paralysis with paraplegia, lower cervical instability, hemivertebra deformity, simple atlantoaxial dislocation, thoracic outlet syndrome , spinal tuberculosis after the sudden deformity considerations Pre-inspection contraindications: Precautions during pregnancy should take certain protective measures to prevent X-rays from affecting the fetus. Before the spine examination, the front side of the spine and the oblique position should be taken. Requirements for inspection: Check the feelings of relaxation, the case may have abnormal pain during the examination, and the actual reaction. Inspection process When checking the spine, the upper body should be removed, the feet should be close together, the lower limbs should be erect, and the hands would naturally sag. Observe the spine on the back. The subject was placed in a standing position with a sputum as the center, and a mark was made at 10 cm and 5 cm below it, and the distance between the two points was measured. Checking the patient's spine activity allows it to pick up an item placed on the ground and see if the spine is moving properly. The physician placed the palm of his left hand on the top of the patient's head, and the right hand and half of the fist punched the left hand of the small fish muscle to observe whether the patient had pain. Not suitable for the crowd Patients with lumbar fractures are not suitable for this examination. Adverse reactions and risks Nothing.

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