TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 25

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 25. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 220 Section Patient Assessment Radicular pain provocation is the key aspect ofthe Lasegue sign Do not overlook a hip joint disorder Lying Supine In the supine position the neurological examination can be completed with regard to the assessment of muscle strength dorsiflexion of the foot L4 and greater toe L5 muscle strength for inversion L5 and eversion S1 of the foot long tract signs Babinski Gordon Oppenheimer Rossolimo see Chapter 11 abdominal reflexes see Chapter 11 presence of any spasticity of the lower extremities see Chapter 11 Lhermitte sign Straight leg raising test The Lhermitte sign is provoked by forceful flexion of the head. The test is positive if the patient has a sensation of electrical shocks in the body and lower extremities. This sign is indicative of a severe spinal cord compression. There is a plethora of descriptions of the Lasegue sign test . We regard the test as positive in the presence of radicular leg pain. It is important to precisely ask the patient what they are experiencing while the straight leg is raised. We always note the elevation degree when radicular pain is experienced. Any other sensation than radicular pain is not regarded as a true Lasegue sign and can be described as a pseudolase-gue sign. The latter sign does not exclude the presence of a radiculopathy but is often caused by a severe muscle spasm. Most frequently the patient is just experiencing tension in the popliteal fossa as a result of tight hamstrings. A cross-over sign is present when the patient experiences radicular pain in the affected leg while raising the contralateral leg and is highly predictive of a large median disc herniation 18 . While the patient is in the supine position the hips should be examined so as not to overlook a hip pathology which is frequent in elderly patients. The diagnosis of an affection of the sacroiliac joint is very difficult clinically because this joint is not easily accessible. It is possible to compress or distract the .

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