脊柱疾病-腰椎檢查的標準化程序

脊柱疾病的物理治療

腰椎檢查的標準化程序OutlineAnatomyHistoryObservationMovementtestsPalpationNeurologicexamSpecialtestsAnatomyFivelumbarvertebraeFivepairs(10total)facetjointsIntricateligamentoussupportAnterior&posteriorlongitudinalInterspinous&supraspinousIntervertebraldisksAnnulusfibrosus20concentriccollarlikeringscriss-crossedforstrengthNucleuspulposusFluidgraduallychangestofibrocartilage

豎肌Erectorspinae背闊肌Latissimus

dorsi斜肌Obliques斜方肌TrapeziusSegmentalmuscles棘間肌Interspinales橫突Intertransversarii回旋肌Rotatores腹部AbdominalsIlliopsoasHamstringsQuadricepsHistory

Locationofpain:Localizedorradiating?

Onsetofpain:Acute,chronic,insidious?

Consistencyofpain:Constant/intermittent?Improves/Worsenswithactivity?

Mechanism:MOIFlex,ext,rotation,lat.FlexDirectblow/traumaHistory(cont.)PMHofinjuries/surgery?Smoker?

Bowel/bladdersymptoms?IncontinenceorfrequencyImmediatereferral

ReferralhistoryTimeinthemedicalsystem?#ofphysiciansseen?History:Pain(cont.)Relievedbyrest?Arethereanyabnormalsensationssuchasnumbness,tingling,burning,orradiatingpain?Paralysisorparesthesia?Didthesymptomsoccurrightawayorlater?Doyouhaveanyproblemssleeping?Whattypeofactivitycausespain?Isthepainaffectedbylaughing,coughing,orsneezing?History:(previousinjury)

Wasthereanypreviousinjury?Whatwastheassessment?Whatwastheassessment?Whatwasthetreatment?Wereyoufullyrecovered?Observation

SagittalcurvatureScoliosisFrontalcurvatureNormalcurvesTorticollisorwryneckLordosisKyphosisStandingpostureShouldersHeadWalkingposture(gait)姿勢（Posture）正常排列（Normalalignment）從正確的姿勢判斷常見的姿勢偏差（Commondeviationsfromnormalposture）⊕傾斜背（swayback）包括骨盆前傾（anteriorpelvictilt）⊕平背（flatback）包括骨盆后傾（posteriorpelvictilt），腰椎前突lordosis會變平﹑髖關(guān)節(jié)伸直（extension）﹑下胸椎會變直⊕后凸前凸（kypholordosis）⊕偏移（shift）姿勢通常是因為椎間盤凸出（discherniation）或關(guān)節(jié)（facetjoint）受到急性刺激。為減輕疼痛。Observation(cont.)ParavertebralmusclesSymmetry/spasmPSISlevelOverallattitudeMovementtests

Active+PassiveInstanding:FlexionExtensionLateralflexionR+L(“sidebending”)RotationLeftandrightMovementtests(cont.)InsupineNeurologicalexamination：SLR/NFS.I.J.tests：compression/distractionstraightlegraisingtestSLRSICompressionandDistractionTests

Inprone:

Neurologicalexamination：PKB

≤0~90°+ve,FemoralNerve

＞90°+ve,Hipjt.

S.I.J.testsPronekneebendingtestNeurologicExam:sensorySensorydermatomesC2-C3:OccipitalareaandangleofjawC4:SupraclavicularareaAxillaryNervePatch:LateralaspectofshoulderC5:LateralupperarmC6:Lateralforearm,thumb,andindexfingerC7:MiddlefingerandpalmaraspectofhandC8:Smallfinger,ringfinger,andmedialportionofpalmarsurfaceSensorydermatomesT1:MedialsideofforearmandelbowT2:MedialaspectofupperarmT3:MedialaspectofupperarmT10:UmbilicusL2:Medialmid-thighL3:Superioraspectofmedialknee(vastus

medialis)L4:KneeandmedialarchL5:DorsumofthefootS1:LateralborderandlateralaspectoffootS2:Popliteal

fossaC1-C2:NeckflexionC1-C2:NeckextensionC3:NecklateralflexionC4:ShoulderelevationC5:ShoulderabductionandexternalrotationC6:ElbowflexionandwristextensionC7:ElbowextensionandwristflexionC8:ThumbabductionandulnardeviationNeurologicExam:motorT1:FingerapproximationL2:HipflexionL3:KneeextensionL4:Dorsiflexion

L5:Greattoeextension,ankledorsiflexion,ankleeversion

S1:Plantarflexion

S2:KneeflexionNeurologicExam:reflexesBiceps(C5-C6)Supinator(C5-C6)Triceps(C7-C8)Upperabdominal(T8-T10)Lowerabdominal(T11-T12)Patella(L3-L4)KJAchillestendon(S1-S2)AJBabinski/Clonus–spinalcord

Palpationskin

TemperatureSweating

Colour

PalpationsofttissueSupraspinousligamentsInfraspinousligamentsParaspinalmusclesAnteriorabdominalmuscles5

ParavertebralmusculatureSymmetryspasmPalpation

boneTransverseprocessesSpinousprocessesPSISScapulaSacrumCoccyxIliaccrestASISIschial

tuberosityPassiveaccessoryinter-vertebralmovementSpecialtestsSlumptest可以看硬膜的活動度。StraightlegraisingtestPronekneebendingtestScreeningtest

HipKneeAnklefoot…課堂小結(jié)解剖學基礎(chǔ)病因病理生物力學方面主觀檢查(S/E)客觀檢查(O/E)

1.視診(Observation)

2.主動運動(ActiveMovements)

3.被動運動(PassiveMovements)

4.等長抵抗運動(ResistedIsometricMovements)

5.外周關(guān)節(jié)的篩查(PeripheralJointScanningExamina