Physical Examination of the Spine PDF
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Preface
In this world of increasing sophistication of diagnostic modalities used in spinal care (diskograpy, fluoroscopy, CT scan, MRI, PET scanning), physicians often become less reliant on their clinical senses in managing disorders of the spine. No piece of technology can assimilate the myriad of diagnostic cues into an understanding of a patient’s overall clinical state better than a well-performed history and physical. It is our hope that this book will help medical students, residents, fellows, and allied health professionals such as physical therapists and nurses understand and improve their spinal diagnostic capabilities through a well-executed and comprehensive physical examination.
The history is the first opportunity a healthcare provider has to understand a patient’s problem and it helps direct a more systemsfocused physical examination. This is especially important in patients with spinal disorders where a history can help exclude many other causes of disability that may not be spine related. An example of this is the common complaint of spinal stenosis. If a patient presents with a complaint of significant leg pain while standing upright or walking but obtains relief when sitting, the astute spinal diagnostician may consider the diagnosis of lumbar spinal stenosis (neurogenic claudication). The physical examination allows the physician to evaluate for signs that may exclude or be indicative of other causes for these symptoms such as vascular insufficiency or degenerative joint disease. Spinal imaging is used mostly to confirm the clinician’s diagnostic suspicion and help outline a treatment plan as more advanced therapy becomes necessary.
This book is divided into anatomic regions of the spine (cervical, thoracic, lumbosacral) and has a standard structure for each region for ease of understanding; that is, inspection, range of motion, motor, sensory, and reflex examination, and special tests for that region. A special section on spinal deformity is included because this is often poorly covered in physical examination textbooks. Spinal care physicians will learn a great deal about the importance of a comprehensive examination from this textbook and will enjoy reviewing it as they improve and practice their clinical skills.
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