Waleed Awwad MD FRCSC Anatomy Spinal Column Anatomy

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Waleed Awwad, MD, FRCSC

Waleed Awwad, MD, FRCSC

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Column

Anatomy • Spinal Cord

Anatomy • Spinal Cord

Anatomy • Spinal Cord

Anatomy • Spinal Cord

Physical exam • Inspection. • Gait. • Palpation. • Range of motion. • Manipulation

Physical exam • Inspection. • Gait. • Palpation. • Range of motion. • Manipulation ( Neurologic Ex ). • Special tests.

inspection • Surface anatomy and alignment • Coronal and sagittal alignment • Shoulder level

inspection • Surface anatomy and alignment • Coronal and sagittal alignment • Shoulder level • Thoracic hump • Waist symmetry • Pelvic obliquity • Skin lesions

gait • Shuffling and slap foot gait • Broad-based gait • Antalgic gait

gait • Shuffling and slap foot gait • Broad-based gait • Antalgic gait

palpation • Spinous process for tenderness or step • Musculature for spasm

palpation • Spinous process for tenderness or step • Musculature for spasm

Range of Motion • Cervical spine • Thoracic spine Flexion and extension, Modified Schober

Range of Motion • Cervical spine • Thoracic spine Flexion and extension, Modified Schober test and chest expansion. • Lumber spine

Neurologic • Muscle Test • Sensory exam light touch, Sharp dull discrimination, Vibration sense,

Neurologic • Muscle Test • Sensory exam light touch, Sharp dull discrimination, Vibration sense, Proprioception and two -point discrimination • Reflexes

Neurologic Sensory Levels C 5 over deltoid C 6 Thumb C 7 Middle finger

Neurologic Sensory Levels C 5 over deltoid C 6 Thumb C 7 Middle finger C 8 Little finger T 4 Nipple T 8 Xiphisternum T 10 Umbilicus T 12 Symphysis pubis L 4 medial aspect of calf L 5 Web space 1 st & 2 nd toe S 1 Lateral border of the foot S 4 -5 Perianal region

Neurologic • Myotomes C 5 Deltoid C 6 wrist extensors C 7 Elbow extensors

Neurologic • Myotomes C 5 Deltoid C 6 wrist extensors C 7 Elbow extensors C 8 finger flexors T 1 Small finger abductor ( lower thoracic nerve root –Beever sign ) L 2 Hip flexors L 3 -4 Knee extensors L 4, 5 S 1 Knee flexion L 5 Ankle and big toe dorsiflextion S 1 Ankle planter flexors

Neurologic • Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex Abdominal reflexes Knee, ankle, planter

Neurologic • Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex Abdominal reflexes Knee, ankle, planter reflex

Special test • Nerve Tension Tests Upper limb tension test Lower limb tension test

Special test • Nerve Tension Tests Upper limb tension test Lower limb tension test Strait-leg raising test (SLRT) Crossed SLRT Lasegue’s test Femoral nerve stretch test

Special test • Axial compression test • Spurling’s test • Nonorganic signs of Waddell

Special test • Axial compression test • Spurling’s test • Nonorganic signs of Waddell Simulation test (axial compression, rotation simulation) Non anatomic tendrness Distraction sign Regional sensory or motor disturbance Overreaction

Thank you

Thank you