11. Spine exam

Question 1

normal curvature of the spine

Answer 1

The cervical and lumbar spines should be lordotic with a balanced thoracic kyphosis.

Question 2

what is scoliosis

Answer 2

abnormal, lateral (sideways) curvature of the spine

Question 3

why should you look for cafe au lait spots during a spine exam

Answer 3

neurofibromatosis type 1 is associated with Scoliosis

Question 4

How many of each vertebrae?

Answer 4

Think about meal times… 7am, 12pm, 5pm

Cervical - 7

thoracic - 12

Lumbar - 5

Sacrum (5, fused)

Coxyx (4, fused)

Question 5

At what vertebral level is the end of the spinal cord?

Answer 5

L1 usually

Question 6

A palpable step at the lumbosacral junction

Answer 6

indicates spondylolisthesis.

Question 7

for tenderness over the sacroiliac joints

Answer 7

ankylosing spondylitis

Question 8

normal range flexion of cervical spine

Answer 8

chin able to touch chest

Question 9

normal range cervical extension

Answer 9

50°

Question 10

what may limit cervical lateral flexion and lateral rotation

Answer 10

painful conditions or in a fused spine

Question 11

how to measure lateral flexion

Answer 11

Ask the patient to stand erect with hands at their sides and feet
30cm apart. Measure the distance from the fingertips to the floor. Ask the patient to flex maximally to the side and re-measure the distance from the fingertips to the
floor.

The difference between the two measurements is recorded as the amount of lateral flexion (normal >10cm).

Question 12

normal lateral flexion

Answer 12

> 10cm

Question 13

normal range of rotation spine

Answer 13

normal range of rotation is 40°

Question 14

what part of the spine is responsible for rotation

Answer 14

almost entirely thoracic. The lumbar
contribution is <5°.

Question 15

causes percussion tenderness

Answer 15

infection, fractures and
neoplasia

Question 16

what specifal test may you do if you suspect ankylosing spondylitis

Answer 16

Assess chest expansion at the level of the fourth intercostal space (normal = 3-5cm). This may be reduced in ankylosing spondylitis.

Question 17

how to perform schobers test

Answer 17

mark L5 spinous process
mark 10cm above this

difference between these marks in erect and flexed position = outcome of lumbar flexion

Question 18

how to perform modified schobers

Answer 18

mark PSIS
A second line is marked 5 cm below the first line.
A third line is marked 10 cm above the first line.

should increase from 15cm to at least 20cm for normal

Question 19

o/e signs of osteoporotic vertebral fracture

Answer 19

Loss of height: vertebral osteoporotic fractures of lead to compression of the spinal vertebrae hence a reduction in overall length of the spine and thus the patient becomes shorter

Kyphosis (curvature of the spine)

Localised tenderness on palpation of spinous processes at the fracture site

Question 20

examination findings cervical spondylosis

Answer 20

Reduced range of movement of neck (in all directions)
Poorly localised tenderness
Signs of radiculopathy (most commonly affecting nerve roots C5 to C7)
Unilateral neck, shoulder or arm pain, paraesthesia, or hyperaesthesia
Diminished arm reflexes (triceps: C7, biceps: C5/C6, supinator: C5/C6).
A small number (<0.1% of patients with cervical spondylosis) of patients with associated acute myelopathy can develop quadriplegia.