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Ebook :Clinical Tests for the Musculoskeletal System

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Differential diagnosis of back pain is often a daunting task given the wide range of possible causes that must be considered. Terms such as “cervical spine syndrome” or “lumbar spine syndrome” are ambiguous as they identify neither the location nor the nature of the disorder. Oncethehistoryhasbeentaken,anyexaminationofthespineshould be preceded by a general physical examination. This required to properly evaluate those changes in the spine that are attributable to causes elsewhere in the body such as in the limbs and muscles. The examination begins with inspection. General body posture is noted, and the position ofthe shouldersand pelvis (levelofthe shoulders, comparison ofbothshoulderblades,levelofthe iliaccrests,lateralpelvicobliquity), vertical alignment of the spine (any deviation from vertical), and the profile of the back (kyphotic or lordotic deformity, or absence of physiologic kyphosis and/or lordosis) are evaluated. Palpation can detect changes in muscle tone such as contractures or myogelosis and can identify tender areas. The active and passive mobility of the spine as a whole and the mobility of specific segments are then evaluated.

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