MSK Spine Examination

Question 1

What is the first step?

Answer 1

Introduce self
Ask patient’s name and DOB
Explain procedure and gain consent

Question 2

What do you do after introducing yourself?

Answer 2

General inspection of the joint from all sides - looking for scars, muscle wasting, asymmetry, spinal alignment ( cervical lordosis, thoracic kyphosis, lumbar lordosis), scoliosis, bruising
Ask patient to walk a few steps

Question 3

What do you do after general inspection?

Answer 3

Palpation -

Feel all the spinous processes
Feel the sacroiliac joints
Feel the paraspinal muscles

Question 4

What do you do after palpation?

Answer 4

Passive movement

C Spine - extension, flexion, rotation
Lumbar spine - flexion ( touch toes), extension, lateral abduction ( hands to lateral calf)
Thoracic spine - patient sit down and put hands on opposite shoulders and rotate body

Question 5

What do you do after movements?

Answer 5

Schober’s test

Identify the location of the posterior superior iliac spine (PSIS) on each side.

2. Mark the skin in the midline 5cm below the PSIS.
3. Mark the skin in the midline 10cm above the PSIS.
4. Ask the patient to touch their toes to assess lumbar flexion.
5. Measure the distance between the two lines.

Should increase from 15cm to 20cm

Question 6

What do you do after Shober’s test?

Answer 6

Sciatic stretch test

Patient lying on back , passively lift their leg and dorsiflex their foot

Question 7

What do you do after Sciatic Stretch test?

Answer 7

Femoral stretch test

Ask patient to lie on their back, flex their leg to 90 degrees then plantarflex their foot

Question 8

What would you do to complete the examination

Answer 8

Present findings

Neurovascular examination of the upper and lower limbs.
Examination of the hip and shoulder joints.
Further imaging if indicated (e.g. X-ray/MRI).