Spinal stenosis physical examination: Difference between revisions

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==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.


OR
Physical examination of patients with spinal stenosis is usually remarkable for [finding 1], [finding 2], and [finding 3].


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with spinal stenosis usually appear normal.  


===Vital Signs===
===Vital Signs===
 
*Patients with spinal stenosis usually have a normal vital signs.
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with spinal stenosis is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* In patients with cervical spinal stenosis, neck physical examination may be positive for:
OR
**Neck pain and tenderness<ref name="pmid19626174">{{cite journal| author=Meyer F, Börm W, Thomé C| title=Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. | journal=Dtsch Arztebl Int | year= 2008 | volume= 105 | issue= 20 | pages= 366-72 | pmid=19626174 | doi=10.3238/arztebl.2008.0366 | pmc=2696878 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19626174  }} </ref><ref name="pmid15195045">{{cite journal| author=Kukurin GW| title=The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up. | journal=J Manipulative Physiol Ther | year= 2004 | volume= 27 | issue= 5 | pages= e7 | pmid=15195045 | doi=10.1016/j.jmpt.2004.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195045  }} </ref>
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with spinal stenosis is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with spinal stenosis is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with spinal stenosis is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with spinal stenosis is usually positive for:
OR
**[[Lower back pain]] and tenderness<ref name="pmid19490371">{{cite journal| author=Kuramoto A, Chang L, Graham J, Holmes S| title=Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation. | journal=J Neuroimaging | year= 2011 | volume= 21 | issue= 1 | pages= 92-4 | pmid=19490371 | doi=10.1111/j.1552-6569.2009.00382.x | pmc=3157482 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19490371  }} </ref><ref name="pmid20227646">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }} </ref>
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Genitourinary]] examination of patients with spinal stenosis is usually positive for:
OR
**[[Scrotal]] and [[perianal]] [[claudication]]<ref name="pmid25705342">{{cite journal| author=Oh JY, Tan JH, Teo TW, Hee HT| title=Spinal stenosis presenting with scrotal and perianal claudication. | journal=Asian Spine J | year= 2015 | volume= 9 | issue= 1 | pages= 103-5 | pmid=25705342 | doi=10.4184/asj.2015.9.1.103 | pmc=4330204 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25705342  }} </ref>
*A pelvic/adnexal mass may be palpated
 
*Inflamed mucosa
 
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with spinal stenosis is usually positive for:
OR
 
*Patient is usually oriented to persons, place, and time
** Hyperreflexia<ref name="pmid26430589">{{cite journal| author=Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH et al.| title=Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis. | journal=Global Spine J | year= 2015 | volume= 5 | issue= 5 | pages= 366-71 | pmid=26430589 | doi=10.1055/s-0035-1549031 | pmc=4577327 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26430589  }} </ref><ref name="pmid24303344">{{cite journal| author=Akhavan-Sigari R, Rohde V, Alaid A| title=Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain. | journal=J Neurol Surg Rep | year= 2013 | volume= 74 | issue= 2 | pages= 101-4 | pmid=24303344 | doi=10.1055/s-0033-1349202 | pmc=3836946 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303344  }} </ref><ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Altered mental status
**positive Romberg test
* Glasgow coma scale is ___ / 15
**Decrease in upper extremity sensation<ref name="pmid24303344">{{cite journal| author=Akhavan-Sigari R, Rohde V, Alaid A| title=Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain. | journal=J Neurol Surg Rep | year= 2013 | volume= 74 | issue= 2 | pages= 101-4 | pmid=24303344 | doi=10.1055/s-0033-1349202 | pmc=3836946 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303344  }} </ref><ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Clonus may be present
**Weak knee and ankle reflexes<ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Hyperreflexia / hyporeflexia / areflexia
** Leg muscle weakness bilaterally<ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
**Positive straight leg raise test<ref name="pmid25983767">{{cite journal| author=Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S| title=The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica. | journal=J Res Med Sci | year= 2015 | volume= 20 | issue= 2 | pages= 150-3 | pmid=25983767 | doi= | pmc=4400709 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25983767  }} </ref>
* Muscle rigidity
 
* Proximal/distal muscle weakness unilaterally/bilaterally
**Abnormal gait<ref name="pmid20404954">{{cite journal| author=Kim YS, Park SJ, Oh IS, Kwan JY| title=The clinical effect of gait load test in two level lumbar spinal stenosis. | journal=Asian Spine J | year= 2009 | volume= 3 | issue= 2 | pages= 96-100 | pmid=20404954 | doi=10.4184/asj.2009.3.2.96 | pmc=2852081 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404954  }} </ref>
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
 
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*Extremities examination of patients with spinal stenosis is usually positive for:
OR
**Bilateral calf muscle atrophy
*[[Clubbing]]
**Weak knee and ankle reflexes
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Muscle atrophy
*Fasciculations in the upper/lower extremity
*Fasciculations in the upper/lower extremity

Revision as of 14:51, 25 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Physical Examination

Physical examination of patients with spinal stenosis is usually remarkable for [finding 1], [finding 2], and [finding 3].


Appearance of the Patient

  • Patients with spinal stenosis usually appear normal.

Vital Signs

  • Patients with spinal stenosis usually have a normal vital signs.

Skin

  • Skin examination of patients with spinal stenosis is usually normal.

HEENT

Neck

  • In patients with cervical spinal stenosis, neck physical examination may be positive for:
    • Neck pain and tenderness[1][2]

Lungs

  • Pulmonary examination of patients with spinal stenosis is usually normal.

Heart

  • Cardiovascular examination of patients with spinal stenosis is usually normal.

Abdomen

  • Abdominal examination of patients with spinal stenosis is usually normal.

Back

  • Back examination of patients with spinal stenosis is usually positive for:

Genitourinary


Neuromuscular

  • Neuromuscular examination of patients with spinal stenosis is usually positive for:
    • Hyperreflexia[6][7][8]
    • positive Romberg test
    • Decrease in upper extremity sensation[7][8]
    • Weak knee and ankle reflexes[8]
    • Leg muscle weakness bilaterally[8]
    • Positive straight leg raise test[9]


Extremities

  • Extremities examination of patients with spinal stenosis is usually positive for:
    • Bilateral calf muscle atrophy
    • Weak knee and ankle reflexes
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

  1. ↑ Meyer F, Börm W, Thomé C (2008). "Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment". Dtsch Arztebl Int. 105 (20): 366–72. doi:10.3238/arztebl.2008.0366. PMC 2696878. PMID 19626174.
  2. ↑ Kukurin GW (2004). "The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up". J Manipulative Physiol Ther. 27 (5): e7. doi:10.1016/j.jmpt.2004.04.009. PMID 15195045.
  3. ↑ Kuramoto A, Chang L, Graham J, Holmes S (2011). "Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation". J Neuroimaging. 21 (1): 92–4. doi:10.1111/j.1552-6569.2009.00382.x. PMC 3157482. PMID 19490371.
  4. ↑ Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052. PMID 20227646.
  5. ↑ Oh JY, Tan JH, Teo TW, Hee HT (2015). "Spinal stenosis presenting with scrotal and perianal claudication". Asian Spine J. 9 (1): 103–5. doi:10.4184/asj.2015.9.1.103. PMC 4330204. PMID 25705342.
  6. ↑ Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH; et al. (2015). "Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis". Global Spine J. 5 (5): 366–71. doi:10.1055/s-0035-1549031. PMC 4577327. PMID 26430589.
  7. ↑ 7.0 7.1 Akhavan-Sigari R, Rohde V, Alaid A (2013). "Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain". J Neurol Surg Rep. 74 (2): 101–4. doi:10.1055/s-0033-1349202. PMC 3836946. PMID 24303344.
  8. ↑ 8.0 8.1 8.2 8.3 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.
  9. ↑ Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S (2015). "The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica". J Res Med Sci. 20 (2): 150–3. PMC 4400709. PMID 25983767.
  10. ↑ Kim YS, Park SJ, Oh IS, Kwan JY (2009). "The clinical effect of gait load test in two level lumbar spinal stenosis". Asian Spine J. 3 (2): 96–100. doi:10.4184/asj.2009.3.2.96. PMC 2852081. PMID 20404954.

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