Case 3 | Examination

 

General inspection

Slim and well presented.  No signs of cachexia.

Back Inspection

  1. Posterior – Nothing obvious
  2. Lateral – Slight thoracic kyphosis
  3. Gait – Unsteady on feet, appears to be having difficulty flexing hip and dorsiflexing feet to clear the ground in the swing phase of his gait.

 

Palpation

Bony tenderness over middle and lower thoracic spine.

No pain or swelling palpable in paraspinal musculature.

 

Movement

Modified Schobers Test:

5 cm.

Extension:

Present but limited by pain in lower thoracic spine

Lateral movements

Normal

 

Neurological examination

 

 Motor power

Overall, bilateral lower leg weakness, but very subtle.

 

Power (Lower Limb)

RIGHT

LEFT

Hip flexion

4

4

Knee flexion

5

5

Knee extension

5

5

Ankle dorsiflexion

5

5

Ankle plantar flexion

5

5

Great toe dorsiflexion

4

4

Great toe plantar flexion

5

5

 

 

 

Sensory

Patchy loss of sensation bilaterally in lower limbs but not following a specific dermatome distribution. 

Normal perianal sensation and anal tone.

 

Co-ordination

Normal but has difficulty in crossing over legs due to weakness.

 

Reflexes

Ankle – normal.

Knee – normal.

 

Nerve tension tests

Not indicated as bilateral signs and multiple levels.

 

Other Relevant Examinations

Screening for hip problems - Full range of rotation, painless.

Peripheral pulses  -  Intact.

 

Abdominal examination  - Normal.  No AAA or palpable bladder.