CLIN SKILLS: Back Exam

Question 1

general MSK back exam process

Answer 1

• introduction
• cervical spine: inspection, palpation, move
• thoracolumbar spine: inspection, palpation, move, special tests

Question 2

inspection for cervical and thoracolumbar spine

Answer 2

• general appearance
• muscle bulk
• abnormality
• skin
• swelling
• deformity e.g. lordosis, kyphosis, scoliosis

Question 3

palpation for cervical and thoracolumbar spine

Answer 3

• cervical bony landmarks: C2, C6, C7
• thoracolumbar bony landmarks: T2 (superior angle of scapula), T7 (inferior angle of scapula), L4/L5 (iliac crests)
• for both: palpate spinous processes, intervertebral discs, facet joints (2-3cm lateral to spinous processes)
• effusion
• swelling
• tenderness
• temperature

Question 4

cervical spine (neck) movements ROM

Answer 4

• Flexion (chin to chest) - 45˚
• Extension (look up and back) - 45˚
• Lateral flexion (touch shoulder with ear) - 45˚
• Rotation (look over shoulder to left and right) - 70˚

Question 5

thoracolumbar spine (back) movements ROM

Answer 5

• Flexion (touch toes w/o bending knees) - 75-90˚
• Lateral flexion (reach sideways, L then R) - 20-25˚
• Extension - 20-30˚
• Rotation (while sitting, twist around to each side) - 30-40˚

Question 6

list the special tests for thoracolumbar spine

Answer 6

• schober’s test
• nerve stretch tests: straight leg raising, bragard’s, cross straight-leg raising, femoral stretch

Question 7

schober’s test

Answer 7

• assesses lumbar flexion to test for ankylosing spondylitis
• find PSIS (S2) and mark 5cm below and 10cm above
• ask Pt to bend forward to touch toes (flexion), measure distance b/n 2 lines. Distance should increase by 5cm or more (i.e. 15 + 5 = 20)

Question 8

straight leg raising (lasegue test)

Answer 8

• high sensitivity, low specificity
• Pt lying supine, cup heel in hand and passively flex the hip to 90 deg w/ straightened leg
• positive if pain radiates to calf, pain in back or glutes ONLY is a false positive.

Question 9

bragard’s test

Answer 9

• perform straight leg raising test, stop raising leg when painful
• lower extended leg slightly to relieve pain, dorsiflex ankle
• pain should be relieved

Question 10

cross straight-leg test

Answer 10

• high specificity, low sensitivity for diagnosing lumbosacral radiculopathy (L5-S1)
• raise the leg similar to the straight leg test, any pain will be in the OPPOSITE side

Question 11

femoral stretch test

Answer 11

• Pt lying prone, flex one knee
• may cause pain in anterior/medial thigh by stretching femoral nerve roots L2-L4
• pain aggravated by hip extension