Video

http://geekymedics.com/2010/10/03/spine-examination/

Exam Summary


1. Introduction

  • Introduce yourself and the exam
  • Ask them to expose their back
  • Ask if the patient has any pain
  • Hand hygiene

2. General Inspection

Ask the patient to stand up. Look for:
  • Scars
  • Swelling
  • Redness
  • Muscle wasting
  • Scoliosis - excessive lateral spine curvature
  • Lordosis or Kyphosis - excessive anterior curvature of the spine (lordosis), excessive posterior curvature of the spine (kyphosis)
  • Loss of normal lumbar Lordosis or thoracic Kyphosis
  • Gait aids in the room
Spine curvature.jpg
Spine curvature

3. Gait

Assess:

4. Wall Test

  • Ask the patient to stand straight against a wall
  • A patient with Ankylosing Spondylitis will only be able to get two points of contact but a normal person will have three.

5. Palpation

  • Palpate the spine while the patient is standing up, assessing for:
    • Temperature
    • Tenderness
    • Instability
    • Palpate the Sacroiliac Joints also
  • Repeat by palpating the paraspinal muscles on each side, assessing for:
    • Tenderness
    • Wasting
  • Also palpate:
    • Iliac crests
6. Movement

a. Cervical

  • Flexion - ask the patient to touch their chin to their chest. Normal flexion is 80-90º
  • Extension - ask the patient to lift their chin for the ceiling and bend their back as much as possible. Normal extension is 70º
  • Lateral Flexion - ask the patient to place their ear on each shoulder. Normal lateral flexion is 20-45º
  • Rotation - ask the patient to rotate their head as far as they can to each side. Normal rotation is 90º.

b. Lumbar

  • Flexion - ask the patient to touch their toes. Use a Schober's Test if there is an inflammatory cause of back pain. Two marks 5cm below the Dimples of Venus and 10cm above. The patient is asked toflex and the distance should increase to >20cm (ie a change of >5cm). If the change is less than 5cm lumbar flexion is limited - Normal range of movement is 50-70º
  • Extension - ask the patient to lean back as much as possible. Ensure that they are bending their back rather than their knees - Normal range of movement is 15-25º
  • Lateral Flexion - ask the patient to slide a hand down the side of their leg as far as they can - Normal range of movement is 25-30º

c. Thoracic

  • Rotation - ask the patient to sit, cross their arms and rotate to each side as far as they can.
7. Straight Leg Raise
  • Lie the patient on the bed
  • Perform a straight leg test and dorsiflex the ankle if the patient has no hip pathology. Ask if the movement causes pain - stop if it does. A sciatic nerve problem will cause pain in the 10-60º range.

8. Sacroiliitis

  • Lie the patient prone
    • Look for gluteal wasting
    • Firmly palpate the sacroiliac joint and assess for tenderness
  • Lie the patient on their side
    • Apply firm pressure on the upper pelvic rim and assess for tenderness

9. Other Exams

10. Conclude

Thank the patient and offer assistance.

See Also

Lower Limb Neurological Examination

Citation

Cervical ranges of motion - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1250253/
Lumbar ranges of motion - http://rheumatology.oxfordjournals.org/content/39/12/1337.full.pdf
Back exam - http://geekymedics.com/2010/10/03/spine-examination/
Lumbar curvature image: From http://www.quora.com/What-kind-of-training-should-I-do-to-become-taller


http://geekymedics.com/2010/10/03/spine-examination/Flexion: 70-90 degreesTouch sternum with chin.
Extension: 55 degreesTry to point up with chin.
Lateral bending: 35 degreesBring ear close to shoulder.
Rotation: 70 degrees left & right