Date: 01.07.20

Duration: 1 hour

Online via Microsoft Teams

Reflective Summary:

During this session we went through the objective assessment of the lumbar and thoracic regions.

The format of the assessment involves observation, active movements with overpressure to establish end feel (passive and resisted movements are not applicable), functional movements (special or provacation tests are not applicable), neurological tests and accessory movements (central and unilateral PA).  Palpations are always performed last.

I was a little surprised about this change in approach because for the past two years of our degree have been taught a standardised approach of observation of the patient first and then palpation – ‘Look, feel, move’.  As the question popped up in my mind, it was almost immediately answered by Alex and Mike.  Palpations are performed last in the assessment because it can cause an undesired response of pain.  If we performed palpations first we could aggravate the condition and get false positives when performing ROM and functional movements.  Palpations help us to get an idea of the muscle tone/bulk, hypertorophy, atrophy, bony landmarks.  It is important to distinguish between palpations and PA.  PA is not palpation.  It is important to differentiate between the palpation and accessory movements in your notes.  Finally the appropriate UMNL tests are performed if applicable.

Things to remember:

– We use over pressure with active movements to check the end feel – e.g. blocked end feel in extension for the lumbar region would indicate a facet joint dysfunction.

– Neurological examination helps us to distinguish between muscular and neurological structures e.g. the SLR is performed passively and helps to differentiate between neurological involvement and hamstring tension.  Carry out SLR – if pain occurs at over 45 degrees then it is the sciatic nerve, lower the leg slightly and dorsiflex the foot – if still provokes pain it is positive for the sciatic nerve.  Try the Slump test if the SLR is negative (as it is more sensitive and specific).

– Accessory movement is a movement that the patient cannot perform that we can perform passively – central and unilateral PA. Central PA should be performed first on the spinous process and unilateral PA next on the transverse process to identity which facet joint is the issue.  PAIVMS is the same as PA.

– The UMNL tests applicable for the lumbar region are:

Babinski – L or C shape on the bottom of the foot.

Superficial reflex test – abnormal response = toes fanning

Clonus – deep tendon reflex – Tremor = abnormal reflex

UMNL tests are not applicable for the thoracic region.

I found the session very helpful in reminding me of the process of assessment and will help to prepare me for the third year when more hours will be spent working in a clinic environment.

Areas for further improvement plus action plan:

 

References:

 

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