CLIN MSK Back & Spine Exam Flashcards
Process of Cervical Spine Exam
- HH
- Greet pt
- Introduce yourself
- Identify pt
- Explanation of examination & confidentiality
- Discuss exposure – neck, shoulders & arms should be exposed
- Obtain consent
- Position the pt
- Ask whether the pt is comfortable
- Ask the pt if they are in pain or experiencing any discomfort before the exam.
- General Inspection
a. Aids – specific to exam
b. Posture
c. Pain/discomfort
d. ‘Noting body habitus’
e. Spontaneous movements - Look – from front, sides & behind
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Swelling
g. Deformity
h. Muscle wasting
i. Posture
i. Specifically of the neck
j. Muscle spasms - Feel (normal joint first then joint of complaint) – pt sitting/prone
a. Skin warmth – w back of fingers
b. Tenderness
c. Swelling
d. Bony landmarks – check both sides of pt
i. C2, C6, C7
ii. Spinous processes
iii. Disc/IV space btw vertebrae
iv. Facet joints (palpable approx. 2-3cm lateral to spinous processes)
v. Go down one side and then the other - Move – pt sitting up
a. Active
i. Flexion – chin to chest 45
ii. Extension 45
iii. Lateral bend – shoulder to ear 45
iv. Rotate – 70 - Left
- Right
- Thank pt
- Redress
- Report findings
- Ask if any questions for pts
- HH
Process of Thoracolumbar Spine Exam
- HH
- Greet pt
- Introduce yourself
- Identify pt
- Explanation of examination & confidentiality
- Discuss exposure – back and legs
- Obtain consent
- Position the pt
- Ask whether the pt is comfortable
- Ask the pt if they are in pain or experiencing any discomfort before the exam.
- General Inspection
a. Aids – specific to exam
b. Posture
c. Pain/discomfort
d. ‘Noting body habitus’
e. Spontaneous movements - Look – from front, sides & behind
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Swelling
g. Deformity
h. Muscle wasting
i. Specifically gluteal area/upper legs
i. Posture – comment on natural/exaggerated presence of:
i. Kyphosis
ii. Lordosis
iii. Scoliosis - Can be more easily observed by bending forward of pt
- Checking for uneven shoulder/pelvic regions
j. Signs of congenital abnormalities
i. Midline moles
ii. Tufts of hair
iii. Haemangioma
k. Muscle spasms - Feel (normal joint first then joint of complaint) – pt sitting/prone
a. Skin warmth – w back of fingers
b. Tenderness
c. Swelling
d. Bony landmarks – check both sides of pt
i. T2, T7, L4, L5
ii. Spinous processes
iii. Disc/IV space btw vertebrae
iv. Facet joints (palpable approx. 2-3cm lateral to spinous processes) - Move – pt sitting up
a. Active - Flexion – touch toes 75-90
- Extension 20-30
- Lateral bend – reach sideways
a. Left
b. Right - Rotation – stabilise pt’s pelvis
- Special Tests
a. Schober’s Test – measures limitation in lumbar flexion
i. Identify PSIS (approx. S2)
ii. Mark midline w pen
iii. Mark 5cm below & 10cm above
iv. Ask pt to bend forward in full lumbar flexion
v. Measure distance btw two lines
vi. Distance between the two lines should increase by 5cm or more
b. Nerve Stretch Test
i. Straight Leg Raise Test - Cup pt’s heel in hand
- Try to flex leg to 90 slowly
- Determine site of pain
ii. Bragard’s Test – complete only if pain reported in c. - Lower leg 10o after previous test
- Dorsiflex ankle and ask if pain returns
iii. Cross Straight Leg Raise Test - Repeat c. and ask if pain is present in the other leg (NB: Testing the leg that is not moving)
iv. Femoral Stretch Test – pt in prone - Extend hip
- Flex knee
- Check for pain in anterior/medial thigh.
- Thank pt
- Redress
- Report findings
- Ask if any questions for pts
- HH
Process of Look for Cervical Spine
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Swelling
g. Deformity
h. Muscle wasting
i. Posture
i. Specifically of the neck
j. Muscle spasms
Process of Feel for Cervical Spine
a. Skin warmth – w back of fingers
b. Tenderness
c. Swelling
d. Bony landmarks – check both sides of pt
i. C2, C6, C7
ii. Spinous processes
iii. Disc/IV space btw vertebrae
iv. Facet joints (palpable approx. 2-3cm lateral to spinous processes)
1. Go down one side and then the other
Process of Move for Cervical Spine
i. Flexion – chin to chest 45
ii. Extension 45
iii. Lateral bend – shoulder to ear 45
iv. Rotate – 70
1. Left
2. Right
Process of Look for Thoracolumbar Spine
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Swelling
g. Deformity
h. Muscle wasting
i. Specifically gluteal area/upper legs
i. Posture – comment on natural/exaggerated presence of:
i. Kyphosis
ii. Lordosis
iii. Scoliosis
1. Can be more easily observed by bending forward of pt
2. Checking for uneven shoulder/pelvic regions
j. Signs of congenital abnormalities
i. Midline moles
ii. Tufts of hair
iii. Haemangioma
k. Muscle spasms
Process of Feel for Thoracolumbar Spine
a. Skin warmth – w back of fingers
b. Tenderness
c. Swelling
d. Bony landmarks – check both sides of pt
i. T2, T7, L4, L5
ii. Spinous processes
iii. Disc/IV space btw vertebrae
iv. Facet joints (palpable approx. 2-3cm lateral to spinous processes)
Process of Move for Thoracolumbar Spine
- Flexion – touch toes 75-90
- Extension 20-30
- Lateral bend – reach sideways
a. Left
b. Right - Rotation – stabilise pt’s pelvis
Schober’s Test
i. Identify PSIS (approx. S2)
ii. Mark midline w pen
iii. Mark 5cm below & 10cm above
iv. Ask pt to bend forward in full lumbar flexion
v. Measure distance btw two lines
vi. Distance between the two lines should increase by 5cm or more
Straight Leg Raise Test
- Cup pt’s heel in hand
- Try to flex leg to 90 slowly
- Determine site of pain
What does Schober’s Test measure?
Limitation in lumbar flexion.
Bragard’s Test
ii. Bragard’s Test – complete only if pain reported in c.
1. Lower leg 10o after previous test
2. Dorsiflex ankle and ask if pain returns
Cross Straight Leg Raise Test
- Repeat straight leg raise test and ask if pain is present in the other leg (NB: Testing the leg that is not moving)
Femoral Stretch Test
- Extend hip
- Flex knee
- Check for pain in anterior/medial thigh.
