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Columna Vertebralis
• 5 regions, 33 bones
Regions
– Cervical ( 7 vertebrae)
– Thoracic ( 12 vertebrae)
– Lumbar ( 5 vertebrae)
– Sacral bone (5 fused =
Sacrum)
– Coccygeal bone (4 fused =
coccyx)
The Vertebral Column
• Vertebrae separated by
intervertebral discs
• Intervertebral discs (anulus
fibrosus + nucleus pulposus)
The Vertebral Column
- Spinal Curvatures
concave and convex curves
Curvatures :
• Kyphosis (cervical and
lumbar)
• Lordosis (thoracic and
sacrum)
• Scoliosis (abnormal)
Vertebra
Typical vertebra has :
– Corpus vertebra
– Arcus vertebra (lamina and pedicle)
– Foramen vertebra
– Processus spinosus (1)
– Processus transversus (2)
– Processus articularis superior (2)
– Processus articularis superior(2)
Cervical Vertebrae
Thoracic and Lumbar Vertebrae
Symmetry/ asymmetry
Deformity
Torticolis
Hematoma
PALPATION
Flexion Extension
Ask the patient to bend Ask the patient to till
the head forward the head backward
STEPS THREE STEPS FOUR
Rotation
Again a spatula use a
pointer. Normal range
= 80
Thoracal Physical Examination
Inspection
Palpation
Percussion
Movement
Movement Flexion
• Schober’s method : a 10
cm length of lumbar spine
is used as a base, where a
15 cm length of spine is
employed. Begin by
positioning a tape
measure with the 10 cm
mark level with the
dimples of Venus (which
mark the posterior
superior iliac spines).
Movement Flexion
• Anchor the top of the
tape with a finger and
ask the patient to flex as
far forward as he can.
Movement Flexion
• Flexion in the thoracic
spine may be measured
with the upper point 30
cm from the previous
zero mark.
Movement Extention
• patient arches his back,
assisting him by
steadying the pelvis and
pulling back on the
shoulder
Movement Lateral Flexion
• measure the angle
formed between a line
drawn through T1, S1
and the vertical
Movement Rotation
• The patient should be
seated, and asked to
twist round to each
side. Rotation is
measured between the
plane of the shoulders
and the pelvis. The
normal maximum range
is 40° and is almost
entirely thoracic
Suspected thoracic cord compression
• Use a blunt object such as
the handle of a tendon
hammer to stroke the
skin in each paraumbilical
skin quadrant.
• Failure of the umbilicus to
twitch in the direction of
the stimulated quadrant
suggests cor compression
on that side at the
appropriate level
Suspected thoracic motor root
dysfunction
• Beevor’s sign
The patient places his hands
behind his head, flex his
knees, and sit up
See the movement of the
umbilicus to one side (and
up or down) suggests that
the abdominal muscles on
that side are unopposed
i.e. there is weakness on
the opposite side
Suspected ankylosing spondylitis
• Check the patient’s
chest expansion at the
level of the 4thn
interspace
• Less than 2.5 cm is
regarded as highly
suggestive of ankylosing
spondylitis
Lumbal Examination
Examination of the Vertebra Lumbal
History Taking
Physical Examination
History taking
1. Note the patient’s age and occupation: both
may be relevant.
2. Ask about the onset of the pain
3. Ask about any directly relevant previous
history
4. Ask about the site and nature of the pain
5. Ask about radiation of the pain
6. Ask about motor involvement
7. Make enquiries in the following areas
Inspection
Palpation
Percussion
Movements
Physical Examination
Inspection
Palpation
Percussion
Movements