Spinal OSCE Exam Flashcards
What are the 5 things you should do as part of your introduction?
Wash hands Introduce yourself Confirm pt details Explain examination Gain consent
How should you position the patient?
Expose pt’s upper body.
Position pt standing.
What is the crucial question you should ask before starting the examination?
Ask if the pt currently has any pain.
On first observation, what should you be looking for (around the bed)?
Aids & adaptations eg. walking stick, wheelchair
Which angles should you inspect the pt from?
Front
Side
Behind
Looking at the pt from the front, what 2 things are you assessing?
- Posture of head & neck: symmetry / abnormal position
2. Symmetry of shoulders: note any misalignment
Looking at the pt from the side, what 3 things are you assessing / looking for?
- Cervical lordosis: assess for hyper-lordosis (spondylolisthesis / osteoporosis / discitis)
- Thoracic kyphosis: normal is 20 - 45o. Hyperkyphosis >45o (? vertebral fracture)
- Lumbar lordosis: assess for hyperlordosis (obesity / tight lower back muscles.
Looking at the pt from behind, what 4 things are you looking for / assessing?
- Scars: provide clues as to previous surgery / trauma
- Wasting: paraspinal muscles / back muscles: may suggest chronic immobility
- Scoliosis: lateral curvature of the spine - resembles an ‘S’ shape.
- Abnormal hair growth: spina bifida
What should you palpate to assess for ‘tenderness & alignment’?
Spinal processes & sacroiliac joints
What should you palpate to identify any tenderness or muscle spasms?
Paraspinal muscles
When palpating the spinal processes, sacroiliac joints & paraspinal muscles, where else should you be assessing?
The patient’s face as you palpate the areas - look for signs of pain / discomfort.
What are the 4 active movements used to assess the cervical spine?
Flexion: touch your chin to your chest (Normal ROM = 0 - 80o)
Extension: look up at the ceiling (Normal ROM 0 - 50o)
Lateral flexion: Touch your ear to your shoulder (Normal ROM = 0 - 45o)
Rotation: Turn your head to the left and then to the right (Normal ROM 0 - 80o)
What should you do if you find reduced ROM on active movement?
What should you assess for?
Perform passive movements.
Assess if pain / stiffness / muscle spasm is the restricting factor.
What are the 3 active movements of the lumbar spine that you should assess?
How would you assess these?
Flexion: touch your toes, keeping your legs straight.
Extension: lead backwards as far as possible (Normal ROM = 10 - 20o)
Lateral flexion: slide your L hand down the outer aspect of your L leg as far as possible, keeping your legs straight. Repeat using R arm / R leg.
What thoracic spine movement should you assess? How would you assess this?
Thoracic rotation:
Sit the pt down, with arms crossed across the chest & ask pt to turn side to side.