Spinal stenosis physical examination: Difference between revisions
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Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, [[Lower back pain]] and tenderness, [[Scrotal]] and [[perianal]] [[claudication]], [[Hyperreflexia]], positive [[Romberg's test|Romberg test]], decrease in upper extremity [[sensation|sensation,]] weak knee and [[ankle]] reflexes, leg [[muscle]] weakness bilaterally, positive straight [[leg]] raise test, abnormal [[gait|gait,]] bilateral [[Calf muscle|calf muscle atrophy]], weak [[knee]] and [[Ankle reflex|ankle reflexes]] and muscle [[atrophy]]. | Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, [[Lower back pain]] and tenderness, [[Scrotal]] and [[perianal]] [[claudication]], [[Hyperreflexia]], positive [[Romberg's test|Romberg test]], decrease in upper extremity [[sensation|sensation,]] weak knee and [[ankle]] reflexes, leg [[muscle]] weakness bilaterally, positive straight [[leg]] raise test, abnormal [[gait|gait,]] bilateral [[Calf muscle|calf muscle atrophy]], weak [[knee]] and [[Ankle reflex|ankle reflexes]] and muscle [[atrophy]]. | ||
Spinal stenosis is more likely when<ref name="pmid29031994">{{cite journal| author=Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J et al.| title=Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria. | journal=Spine J | year= 2018 | volume= 18 | issue= 6 | pages= 941-947 | pmid=29031994 | doi=10.1016/j.spinee.2017.10.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29031994 }} </ref>: | |||
* Age over 60 years | |||
* Positive 30-second extension test | |||
* Negative straight leg test | |||
* Pain in both legs | |||
* Leg pain relieved by sitting | |||
* Leg pain decreased by leaning forward or flexing the spine | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with spinal stenosis usually appear normal. | *Patients with spinal stenosis usually appear normal. | ||
| Line 50: | Line 60: | ||
**Weak [[knee]] and [[Ankle reflex|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> | **Weak [[knee]] and [[Ankle reflex|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> | ||
*Muscle [[atrophy]] | *Muscle [[atrophy]] | ||
==References== | ==References== | ||
{{Reflist|2}}{{WH}} {{WS}} | {{Reflist|2}}{{WH}} {{WS}} | ||
[[Category: (name of the system)]] | [[Category: (name of the system)]] | ||
Latest revision as of 04:16, 15 February 2019
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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
Patients with spinal stenosis usually appear normal. Patients with spinal stenosis usually have a normal vital signs.Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, Lower back pain and tenderness, Scrotal and perianal claudication, Hyperreflexia, positive Romberg test, decrease in upper extremity sensation, weak knee and ankle reflexes, leg muscle weakness bilaterally, positive straight leg raise test, abnormal gait, bilateral calf muscle atrophy, weak knee and ankle reflexes and muscle atrophy.
Physical Examination
Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, Lower back pain and tenderness, Scrotal and perianal claudication, Hyperreflexia, positive Romberg test, decrease in upper extremity sensation, weak knee and ankle reflexes, leg muscle weakness bilaterally, positive straight leg raise test, abnormal gait, bilateral calf muscle atrophy, weak knee and ankle reflexes and muscle atrophy.
Spinal stenosis is more likely when[1]:
- Age over 60 years
- Positive 30-second extension test
- Negative straight leg test
- Pain in both legs
- Leg pain relieved by sitting
- Leg pain decreased by leaning forward or flexing the spine
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
- HEENT examination of patients with spinal stenosis is usually normal.
Neck
- In patients with cervical spinal stenosis, neck physical examination may be positive for:
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:
- Lower back pain and tenderness[4][5]
Genitourinary
- Genitourinary examination of patients with spinal stenosis is usually positive for:
Neuromuscular
- Neuromuscular examination of patients with spinal stenosis is usually positive for:
Extremities
- Extremities examination of patients with spinal stenosis is usually positive for:
- Bilateral calf muscle atrophy[12]
- Weak knee and ankle reflexes[12]
- Muscle atrophy
References
- ↑ Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J; et al. (2018). "Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria". Spine J. 18 (6): 941–947. doi:10.1016/j.spinee.2017.10.003. PMID 29031994.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 8.0 8.1 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.
- ↑ 9.0 9.1 9.2 9.3 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.
- ↑ 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.
- ↑ 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.
- ↑ 12.0 12.1 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.