REMS: Spinal examination (geekymedics) Flashcards
(A1) What aids and adaptions should you look for?
> walking stick / wheelchair
(A2) When inspecting from the front what are you looking for?
> Posture of head and neck - symmetry / abnormal position
> Symmetry of shoulders - note any misalignment
(A3) When inspecting from the side what are you looking for?
> Cervical lordosis - assess for hyper-lordosis - spondylolisthesis / osteoporosis / discitis
> Thoracic kyphosis - normal is 20-45 degrees - hyperkyphosis (>45) - vertebral fracture
> Lumbar lordosis - asses for hyper-lordosis - obesity / tight lower back muscles
(A4) When inspecting from the back what are you looking for?
> Scars - previous surgery / trauma
> Wasting - paraspinal muscles / back muscles - may suggest chronic immobility
> Scoliosis - lateral curvature of the spine
> Abnormal hair growth - spinal bifida
(A5) What should be felt on the back and what should be done while performing this?
> Palpate spinal process and sacroiliac joints - assess for tenderness and alignment
> Palpate paraspinal muscles - note any tenderness or muscle spasms
> Observes the patient’s face, look for signs of pain
(A6) How is active movement of the cervical spine assessed?
> Flexion - chin to chest - normal ROM 0-80
> Extension - look to ceiling - normal ROM 0-50
> Lateral flexion - touch ear to shoulder - normal ROM –45
> Rotation - turn head to left and then right - normal ROM 0-80
(A7) If there is reduced ROM on active movements what should be done next?
> Perform passive movements
> Assess if pain / stiffness / muscle spasm is the restricting factor
(A8) How is the active movement of the lumbar spine assessed?
> Flexion - touch your toes keeping your legs straight
> Extension - lean backwards as far as possible - normal ROM 10-20
> Lateral flexion - slide your left hand down the outer aspect of your left leg as far as possible - repeat with other hand and leg
(A9) How is the thoracic spine assessed?
> Thoracic rotation - sit the patient down with arms crossed across the chest and ask to turn side to side
(B1) What special tests should be performed?
> Schober’s test - ROM of lumbar spine
> Sciatic stretch test/straight leg raise
> Femoral nerve stretch test
(B2) What is the normal distance increase in the Schober’s test? What condition does reduced range of motion indicate?
> greater than 20cm
> ankylosing spondylitis
(B3) What does pain in the lower back / which / buttocks during sciatic stretch test suggest?
> sciatic nerve root impingement
(B4) What is a positive result for the femoral stretch test?
> pain felt in the thigh / inguinal region
(B5) After completing the spinal examination, what further assessments and investigations would you suggest?
> Full neuromuscular examination of all 4 limbs
> Perfume further imaging if indicated - X-ray / MRI / CT
(B6) How would you summarise a normal spinal examination?
> Today I performed a spine exam on Simon a 24 y/o male. On palpitation there was no tenderness and there was normal ROM throughout is spine. There were no abnormalites detected on special tests.
> To complete the examination, I will do a full neuromuscular assessment of his upper and lower limbs and consider imaging if appropriate.
