Handbook of Lumbar Spine and Lower Extremity Examination : A Practical Guide

✍ Scribed by Roger Pillemer

• Publisher: Springer Nature Switzerland
• Year: 2023
• Tongue: English
• Leaves: 284
• Edition: 1
• Category: Library

✦ Synopsis

In addition to complementary radiographic imaging, the physical exam is an essential diagnostic element for the orthopedic surgeon. As such, learning to perform this exam thoroughly is of utmost importance to medical students, residents and interns on an orthopedic rotation and in later practice.

This practical text succinctly presents all of the necessary information regarding the physical examination of the lower extremity and lumbar spine. The lower spine, hip, knee, and foot and ankle are discussed in dedicated thematic sections, with each section comprised of three main chapters. The initial chapter describes the musculoskeletal anatomy and function of the joint, presenting the tests themselves along with the rationale for performing them. The second chapter presents the systematic examinations carried out in every case, and the third chapter describes examinations for specific conditions relating to the joint, including tendinopathies, osteoarthritis, neurological conditions, deformities and more. Plentiful bullet points and color images throughout the text describe and illustrate each test and physical sign.

Convenient and user-friendly, Handbook of Lumbar Spine and Lower Extremity Examination is a valuable, portable guide to this all-important diagnostic tool for students and practitioners alike.

✦ Table of Contents

Acknowledgements
Introduction
Terminology: Osteoarthritis Vs Osteoarthrosis
Contents
About the Author
Part I: The Lumbar Spine
1: Anatomy and Function of the Lumbar Spine
1.1 Anatomy
1.2 Function
2: A Systematic Examination of the Lumbar Spine
2.1 The Examination
2.1.1 Patient Standing (Observation)
2.1.2 Gait
2.1.3 Additional Three Tests
2.1.4 Range of Motion
2.2 Supine on the Couch
2.2.1 Straight Leg Raising Test (SLR)
2.2.2 Neurological Examination
2.2.3 Autonomous Zones
2.3 Examination of the Sacroiliac Joint (SIJ)
2.3.1 Distraction Test
2.3.2 Patrick’s Test
2.3.3 Thigh Thrust Test
2.3.4 Gaenslen’s Test
2.3.5 Compression Test
2.3.6 Palpation Tests
2.4 Prone on the Couch
2.4.1 Slump Test
2.4.2 Segmental Innervation of muscles
2.5 Application
2.6 Checklist for Examination of the Lumbar Spine
2.6.1 Patient Standing
2.6.2 Gait
2.6.3 Three Additional Tests
2.6.4 Range of Motion
2.6.5 Supine on the Couch
2.6.6 Prone on the Couch
2.6.7 Additional
3: Examination for Specific Conditions of the Lumbar Spine
3.1 Intervertebral Disc Prolapse
3.1.1 Anatomic Classification (Stages of Disc Herniation)
3.1.2 Location Classification
3.1.3 Symptoms
3.1.3.1 Physical Signs
3.1.4 Investigations
3.1.5 Treatment
3.1.5.1 Non-operative
3.1.5.2 Operative
3.1.5.3 Important Additional Considerations
3.2 Lumbar Sprain and Strain
3.2.1 Lumbar Spinal Stenosis (LSS)
3.3 Cauda Equina Syndrome (CES)
3.3.1 Symptoms
3.3.2 Physical Signs
3.3.3 Investigations
3.3.4 CES Red Flags
3.4 Spondylolysis and Spondylolisthesis
3.4.1 Spondylolysis
3.4.2 Spondylolisthesis
3.4.3 Classification
3.4.4 Grading (Meyerding)
3.4.5 Clinical Presentation
3.4.6 Investigation
3.5 Facet Joint Arthropathy
3.5.1 Symptoms
3.5.2 Signs
3.5.3 Investigations
3.5.4 Diagnosis
3.5.5 Treatment
3.6 Ankylosing Spondylitis (AS)
3.6.1 Investigations
3.6.2 Imaging
3.7 Infections in the Lumbar Spine: Osteomyelitis and Discitis
3.7.1 Definitions
3.7.2 Causes
3.7.3 Epidemiology
3.7.4 Symptoms
3.7.5 Signs
3.7.6 Investigations
3.7.7 Treatment
3.8 The Lumbosacral Plexus
3.8.1 The Lumbar Plexus (Fig. 3.15)
3.8.2 The Sacral Plexus (Fig. 3.16)
Part II: The Hip Joint
4: Anatomy and Function of the Hip
4.1 Movements
4.2 Range of Movement
4.3 Ligaments
4.4 Stability
4.5 Functions
4.5.1 Hip Joint
4.5.2 Acetabular Labrum
5: Systematic Examination of the Hip
5.1 Inspection and Palpation
5.2 Gait
5.3 Supine
5.4 Block Method of Measuring Leg Length
5.5 Trendelenburg Sign (Standing and Gait)
5.5.1 Standing Test
5.5.2 Gait Test
5.5.3 Causes
5.6 Apparent Shortening
5.7 Thomas Test
6: Examination for Specific Conditions of the Hip
6.1 Childhood and Adolescence
6.2 Transient Synovitis (Ages 3–10 Years)
6.3 Developmental Dysplasia of the Hip (DDH)
6.3.1 Clinical Signs in Unilateral Dislocation
6.3.2 Clinical Tests (Under 3 Months Old)
6.3.3 Investigations
6.3.4 Treatment
6.4 Ortolani Test
6.5 Barlow Test
6.6 Galeazzi Test
6.7 Septic (Pyogenic) Arthritis (Usually Under Age 3 Years)
6.7.1 Routes of Infection
6.7.2 Signs and Symptoms
6.7.3 Diagnostic Investigations
6.8 Perthes Disease (Legg-Calve-Perthes Disease)
6.8.1 Classification
6.8.2 Prognostic Factors
6.8.3 Symptoms
6.8.4 Signs
6.8.5 Imaging (X-rays)
6.9 Slipped Capital Femoral Epiphysis (SCFE)
6.9.1 Grading
6.9.2 Aetiology and Risk Factors
6.9.3 Symptoms
6.9.4 Signs
6.9.5 Imaging
6.9.6 Treatment
6.9.7 Triplane Osteotomy
6.9.8 Complications
6.9.9 Something to Think About: A Malunited Femoral Fracture
6.10 Osteoarthrosis (OA) of the Hip
6.10.1 Symptoms
6.10.2 Signs
6.10.3 Imaging
6.10.4 Treatment
6.10.5 Correction of the Malunited Femoral Fracture
6.11 Femoro-Acetabular Impingement (FAI)
6.11.1 Symptoms
6.11.2 Signs
6.11.3 Imaging
6.12 Osteonecrosis of the Femoral Head (Also Known as Avascular Necrosis: AVN)
6.12.1 Causes
6.12.2 Symptoms
6.12.3 Signs
6.12.4 Investigations
6.12.5 Staging (Variously Described)
6.12.6 Prognosis
Part III: The Knee Joint
7: Anatomy and Function of the Knee Joint
7.1 General Considerations
7.2 Movements of the Knee Joint
7.2.1 Patellofemoral Joint
7.2.2 Knee Ligaments
7.2.2.1 Intracapsular: The Cruciate Ligaments
7.2.2.2 Anterior Cruciate Ligament (ACL) (Fig. 7.9)
7.2.2.3 Posterior Cruciate Ligament (PCL) (Fig. 7.9)
7.2.2.4 Menisci
7.2.2.5 Medial Meniscus
7.2.2.6 Lateral Meniscus
7.3 Functions
7.3.1 Load Transmission
7.3.2 Joint Stability
7.3.3 Joint Lubrication and Nutrition
7.3.4 Proprioception
7.3.5 Shock Absorption
7.4 Blood Supply of the Knee
7.5 Nerve Supply
8: A Systematic Examination of the Knee
8.1 Inspection and Palpation
8.1.1 Gait
8.1.2 Range of Movement
8.1.3 Fluid in the Knee
8.1.4 Patellofemoral Joint
8.2 Testing Stability
8.2.1 Collateral Ligaments
8.2.1.1 Medial Collateral Ligament (MCL)
8.2.1.2 Lateral Collateral Ligament (LCL)
8.3 Cruciate Ligaments
8.3.1 Drawer Test
8.3.2 Anterior Cruciate Ligament (ACL)
8.3.2.1 Lachman Test
8.3.2.2 Pivot Shift Test
8.3.3 Posterior Cruciate Ligament (PCL)
8.3.3.1 Posterior ‘Sag’ Test
8.3.3.2 Meniscal Injuries
8.4 Joint Line Tenderness
8.5 McMurray’s Test
8.5.1 Method for Carrying Out the Seated Lumbar Extension Test (SLE TEST)
8.5.2 Points to Emphasise
8.5.3 Explanation
8.5.4 Conclusion
9: Examination for Specific Conditions of the Knee
9.1 Osteoarthrosis of the Knee
9.1.1 Risk Factors
9.1.2 Symptoms
9.1.3 Signs
9.1.4 X-Rays
9.1.5 Treatment
9.1.5.1 Non-operative
9.1.5.2 Operative
9.2 Meniscal Lesions
9.2.1 Symptoms
9.2.2 Signs
9.2.2.1 Locking
9.2.2.2 McMurray’s Test
9.2.2.3 Apley’s Grinding Test
9.3 Knee Ligament Injuries
9.3.1 Signs and Symptoms
9.3.1.1 The Fibular Collateral Ligament: Palpating the Most Palpable Ligament in the Body
9.4 Dislocation of the Patella
9.4.1 Symptoms
9.4.2 Signs
9.5 Recurrent Dislocation of the Patella
9.5.1 Signs and Symptoms
9.6 Extensor Mechanism Failure
9.6.1 Risk Factors
9.6.2 Signs
9.6.3 Investigations
9.7 Osgood Schlatter’s Disease (Tibial Tubercle Apophysitis)
9.8 Osteochondritis Dissecans of the Knee (OCD)
9.8.1 Symptoms
9.8.2 Signs
9.8.3 Imaging
9.8.4 Differential Diagnosis
9.9 Osteonecrosis
9.9.1 Spontaneous Osteonecrosis of the Knee (SONK)
9.9.1.1 Investigations
9.9.1.2 Prognosis
9.9.1.3 Differential Diagnosis
9.9.2 Association with Underlying Conditions
9.10 Swellings of the Knee: More Common Causes
Part IV: The Foot and Ankle
10: Anatomy and Function
10.1 Bones
10.1.1 Talus
10.1.2 Calcaneus (Heel Bone)
10.1.3 Navicular
10.1.4 Cuneiform Bones (Cuneiform = Wedge Shaped)
10.1.5 Metatarsals
10.1.6 Phalanges
10.1.7 Sesamoid Bones
10.2 Joints and Ligaments
10.2.1 Ankle Joint (Talocrural Joint)
10.2.2 Subtalar Joint: Talocalcaneal Joint (ST)
10.2.3 Talocalcaneonavicular Joint (TCN)
10.2.4 Calcaneocuboid Joint
10.2.5 Tarsometatarsal Joints (TMT)
10.2.5.1 Lisfranc Joint/Injury
10.2.6 Other Important Ligaments
10.2.6.1 Lisfranc Ligament
10.2.6.2 Plantar Calcaneonavicular (Spring) Ligament
10.2.6.3 Short Plantar Ligament (Plantar Calcaneocuboid Ligament)
10.2.6.4 Long Plantar Ligament
10.2.6.5 Bifurcate Ligament
10.2.6.6 Tarsal Sinus
10.3 Muscles and Tendons
10.3.1 Extrinsic Muscles
10.3.1.1 Superficial Posterior Compartment
Gastrocnemius
10.3.1.2 Deep Posterior Compartment
10.3.1.3 Anterior Compartment
10.3.1.4 Lateral Compartment
10.3.2 Intrinsic Muscles
10.3.2.1 First Layer (Lies Deep to the Plantar Aponeurosis)
10.3.2.2 Second Layer
10.3.2.3 Third Layer
10.3.2.4 Fourth Layer
10.3.2.5 Plantar Fascia (Aponeurosis)
10.3.2.6 Windlass Mechanism
10.3.3 Arches of the Foot
10.3.3.1 Medial Arch
10.3.3.2 Lateral Arch
10.3.3.3 Transverse Arch
10.3.4 Nerve Supply of the Foot
10.3.4.1 Tibial Nerve (L4,5,S1,2,3)
10.3.4.2 Common Peroneal (Fibular) Nerve (L4,5,S1,2)
10.3.5 Arterial Supply of the Foot
10.3.6 Movements
11: Systematic Examination of the Foot and Ankle
11.1 Inspection and Palpation
11.1.1 Gait
11.1.2 Range of Movement
11.1.3 Ankle Stability
11.2 Neurological Examination
11.3 Vascular Examination
11.3.1 Gait
11.3.2 Foot Drop
12: Examination for Specific Conditions of the Foot and Ankle
12.1 Osteoarthrosis of the Ankle (OA)
12.1.1 Symptoms
12.1.2 Signs
12.1.3 Treatment
12.2 Diabetic Foot Problems
12.2.1 Peripheral Neuropathy
12.2.2 Peripheral Arterial Disease (PAD)
12.2.3 Symptoms
12.2.4 Amputations in Patients with Diabetes
12.3 Conditions Relating to the Hindfoot
12.3.1 Talipes Equinovarus (CTEV)
12.3.1.1 Bony Abnormalities
12.3.1.2 Associated Conditions
12.3.2 Metatarsus Adductus
12.3.3 Talipes Calcaneovalgus
12.3.4 Congenital Vertical Talus (CVT)
12.3.5 Achilles Tendinitis
12.3.5.1 Signs
12.3.6 Achilles Tendon (TA) Rupture
12.3.6.1 Signs
12.3.6.2 Treatment
12.3.7 Heel Pain
12.3.7.1 Plantar Fasciitis
12.3.7.2 Symptoms
12.3.7.3 Signs
12.3.7.4 Treatment
12.3.7.5 Note
12.3.8 Insertional Achilles Tendinitis
12.3.8.1 Calcaneal Bursitis
12.3.8.2 Calcaneal Lesions
12.3.8.3 Haglund’s Deformity
12.3.8.4 Calcaneal Spurs (Heel Spurs)
12.3.8.5 Sever’s Disease (Calcaneal Apophysitis)
12.3.9 Osteochondritis Dissecans of the Talus (OCD)
12.3.10 Tarsal Tunnel Syndrome (TTS)
12.3.11 Sinus Tarsi Syndrome
12.4 Conditions Relating to the Midfoot
12.4.1 Flat Foot (Pes Planus)
12.4.2 Flexible Flat Foot
12.4.3 Rigid Flat Foot
12.4.4 Adult Acquired Flat Foot Deformity (AAFD)
12.4.5 Flat Foot in Children
12.4.6 Pes Cavus
12.4.7 Midfoot Pain
12.4.7.1 Causes
12.5 Conditions Relating to the Forefoot
12.5.1 Hallux Valgus
12.5.2 Hallux Rigidus
12.5.2.1 Symptoms
12.5.2.2 Signs
12.5.2.3 X-Ray
12.5.3 Gout
12.5.3.1 Diagnosis
12.5.3.2 Treatment
12.5.4 Morton’s Neuroma
12.5.4.1 Symptoms
12.5.5 Sesamoiditis
12.5.6 Freiberg’s Disease (Osteochondritis of the Metatarsal Head)
12.5.7 Stress Fractures
12.6 Lesser Toe Deformities
12.6.1 Hammer Toes
12.6.2 Claw Toes
12.6.3 Mallet Toe
12.6.4 In Summary
12.6.5 Symptoms
12.7 Overlapping Fifth Toe
12.8 Tailor’s Bunion (Bunionette)
Figure Credits and Sources
Further Reading
Index

✦ Subjects

Medicine; Orthopedics; Sports Medicine; Sport Science