Spine

Question 1

1

wont ever need to do full spine exam

can be asked:

• shoulder and cervical spine
• hips and lumbar

Answer 1

INTRODUCTION

• Before commencing, ask the patient whether they have any pain in their neck or back.

Question 2

2

Answer 2

Assess gait

Question 3

3

Answer 3

Inspect - Front/Side/Back

Inspect the patient from in front, from the side and from behind
just keep looking at spine, skin, head position etc.

Question 4

4

-examine above clavicle for masses

BEFORE YOU PALPATE

Answer 4

Palpate - face back wall

use three fingers, one on left of spinal column, one in middle and one on right. start at neck

• examine above clavicle for masses
• palpate the sacroiliac joints

Question 5

5

Answer 5

palpate muscles down both sides of spine

Question 6

6

Answer 6

movements

get them to turn back round

Question 7

7

Answer 7

CERVICAL
up to ceiling (hold it there)
down to toes 
look over left shoulder 
look over right shoulder 
left ear to right shoulder
and right ear to left shoulder

Question 8

8

Answer 8

Lumbar (flex/lat flex/ext)

LUMBAR FLEXION

-touch toes

Question 9

9

Answer 9

LUMBAR EXTENSION (go back)

and now lean back as far as your comfortably able to

Question 10

10

Answer 10

LATERAL FLEXION

Feet 30 cm apart
with your right arm reach down on your left leg as far as possible
and do the same on the other side
AND MEASURE HOW FAR OFF THE GROUND (<10 cm is normal)

Question 11

11

IGNORE THIS ONE

Answer 11

THORACIC ROTATION

Ask patient to be seated.
“cross your arms for me. and turn your body round to the right as far as you can, and to the left”

Question 12

12

Answer 12

SCHOBERS TEST (Measure and pen)

Use your thumbs to feel the posterior iliac spines (two sticky out things at lower back) then mark an x with a pen in between them on the spine. measure 10cm above and 5 cm below.
Get them to flex and measure again - it shouldn’t increase by more than 5cm

Question 13

13

Answer 13

Percussion down the spine

-Ask the patient to bend forward and lightly percuss the spine from the root of the neck
to the sacrum

Question 14

14

Answer 14

Special tests (only do these if it specifically says)

Question 15

15

If history says prolapsed disk do these 2:

although it did these 2 on geeky medics so if in doubt do them. dont do AS one

Answer 15

Straight leg raise
(lie them down)

“I’m now going to lift each leg up straight, please let me know if you get any pain in your back or leg”

Lift leg up to 45 and then at top bend foot towards pt

Question 16

16

Answer 16

Femoral stretch test

“turn over on to front for me. I’m now going to lift each leg, do let me know if you have any pain at all”

Hold ankle and flex knee to 90 and then put hand on to bottom of thigh and lift the leg up

Question 17

17

If suspect ankolysing spondyltiits

Answer 17

Chest expansion

Question 18

18

Answer 18

Summary

…. he had a normal gait.
On palpation no tenderness of spine or paraspinal muscles.
He had a full range of movement.
This was a normal spinal exam

complete
complete a full neurovascular examination of the upper and lower limbs

Question 19

NECK PAIN = SHOULDER EXAM

BACK PAIN = ABDO, RECTAL, HIP EXAM

Answer 19

note:
someone with lower back pain, perform an abdominal examination and rectal exam (masses, cauda equina syndrome)
In patients presenting with neck pain, you should also examine the shoulder joints.