Podcast
Questions and Answers
What are the main reasons for referral to a spinal clinic?
What are the main reasons for referral to a spinal clinic?
The common reasons for referral to a spinal clinic are pain and spinal deformity.
What vital historical information should be gathered during a spinal assessment?
What vital historical information should be gathered during a spinal assessment?
Important historical information includes the site, type, severity, duration, frequency of pain, and any aggravating factors.
What is the significance of identifying 'red flags' during spinal evaluations?
What is the significance of identifying 'red flags' during spinal evaluations?
Identifying 'red flags' helps in triaging patients with serious spinal pathologies like fractures and infections.
How does skeletal maturity affect the assessment of spinal deformity progression in children?
How does skeletal maturity affect the assessment of spinal deformity progression in children?
What does the Adam's forward bend test reveal in patients suspected of scoliosis?
What does the Adam's forward bend test reveal in patients suspected of scoliosis?
Which skin conditions are indicative of neurofibromatosis during a spinal examination?
Which skin conditions are indicative of neurofibromatosis during a spinal examination?
Why is palpation an important part of a spinal examination?
Why is palpation an important part of a spinal examination?
What are the normal ranges of motion for the cervical spine?
What are the normal ranges of motion for the cervical spine?
What is the normal range of motion for lumbar spine flexion?
What is the normal range of motion for lumbar spine flexion?
What does a Schober's test measure?
What does a Schober's test measure?
List two neurological examination areas that should be focused on in patients with back pain.
List two neurological examination areas that should be focused on in patients with back pain.
What might a distance of less than 5 cm in Schober’s test indicate?
What might a distance of less than 5 cm in Schober’s test indicate?
What is one possible consequence of absent or asymmetrical abdominal reflexes?
What is one possible consequence of absent or asymmetrical abdominal reflexes?
Identify two 'red flags' that suggest serious underlying pathology in patients with back pain.
Identify two 'red flags' that suggest serious underlying pathology in patients with back pain.
What symptoms should healthcare providers inquire about to assess for cauda equina syndrome?
What symptoms should healthcare providers inquire about to assess for cauda equina syndrome?
Name one non-spinal cause that may result in low back pain.
Name one non-spinal cause that may result in low back pain.
Flashcards
Spinal Clinic Referral Reasons
Spinal Clinic Referral Reasons
Common reasons for referral include pain and spinal deformity.
Pain History Detail
Pain History Detail
A comprehensive pain history (location, type, severity, duration, frequency, triggers) is necessary.
Trauma History in Spine Pain
Trauma History in Spine Pain
Questioning about any prior trauma is important for diagnosis.
Scoliosis Assessment
Scoliosis Assessment
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Forward Bend Test
Forward Bend Test
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Neurofibromatosis Clues
Neurofibromatosis Clues
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Red Flags in Spine
Red Flags in Spine
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Cervical Spine Movement
Cervical Spine Movement
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Schober's test
Schober's test
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Normal lumbar spine range of motion
Normal lumbar spine range of motion
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Cauda equina syndrome
Cauda equina syndrome
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Red flags in back pain
Red flags in back pain
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Superficial abdominal reflex
Superficial abdominal reflex
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Ankylosing spondylitis
Ankylosing spondylitis
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Neurological exam of limbs
Neurological exam of limbs
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Rectal exam
Rectal exam
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Study Notes
Spinal Clinic Referral Reasons
- Common reasons for referral include pain and spinal deformity.
- Detailed pain history is crucial, including location, type, severity, duration, frequency, and aggravating factors.
- Trauma history, night pain, associated pain (brachalgia/sciatica), numbness, tingling, weakness, gait difficulties, and family history of ankylosing spondylitis/rheumatoid arthritis should be assessed.
- Concurrent medical conditions (diabetes, vascular diseases, hip OA, previous malignancies) and systemic symptoms (weight loss, chills, fever) are also important.
- Table 33.1 lists "red flags" for serious spinal pathology (fractures, tumors, infection, cauda equina syndrome).
Spinal Deformity Assessment in Children
- Assess the progression rate of spinal deformity.
- Evaluate skeletal maturity and recent growth spurts.
- Puberty indicators (menstruation, voice change) should be noted.
Physical Examination
- Assess posture (frontal and sagittal planes) for asymmetry (scoliosis).
- Adam's forward bend test accentuates trunk asymmetry, identifies rib/loin prominence.
- Skin examination should look for neurofibromatosis markers (cutaneous neurofibromata, café-au-lait patches, axillary freckling).
- Neurological examination should include abdominal reflexes, leg length measurement, and sagittal alignment/forward gaze (for kyphosis).
Spinal Mobility Assessment
- William Adams described the forward bend test for scoliosis (1865).
- Palpation for tenderness and range-of-motion assessment are necessary.
- Normal cervical range of motion: flexion (45°), extension (55°), rotation (70°), lateral bend (40°).
- Normal lumbar range of motion: flexion (40-60°), extension (20-35°), lateral bend (15-20°), rotation (3-18°).
- Schober's test assesses spinal mobility by measuring distance between points on the spine during flexion (at least 5cm increase expected).
Neurological Examination
- Neurological examination focuses on tone, power, coordination, reflexes, sensation, and gait (Tables 33.4 and 33.5).
- Rectal examination is necessary if cauda equina integrity is suspected.
- Superficial abdominal reflexes should be symmetrical (umbilical movement follows stroking and should be bilateral).
Red Flags and Serious Pathology
- Table 33.1 outlines "red flags" indicating potential serious spinal pathology.
- Age, trauma history, malignancy history, weight loss, constitutional symptoms (fever, chills), immunosuppression, progressive sensory/motor issues, urinary/fecal difficulties, and perineal numbness should be carefully assessed.
Non-Spinal Pain Considerations
- Non-spinal causes of low back pain must be considered (Table 33.2), including respiratory, vascular, renal, gastrointestinal, and urogenital issues (e.g., mesothelioma, aneurysm, pyelonephritis, peptic ulcer).
Patient History and Concerns
- Evaluate the impact of pain on the patient's ability to work.
- Inquire about existing treatments.
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Description
This quiz covers key aspects related to spinal clinic referrals, including common reasons for referral such as pain and spinal deformity. It also addresses assessment methods for spinal deformity in children and the importance of detailed physical examinations. The quiz emphasizes the significance of recognizing 'red flags' in spinal pathology.
