Spine

Question 1

What do you do to start the examination?

Answer 1

Wash hands
Introduction
Identification
Consent
Exposure

Question 2

What exposure is required for a spinal examination?

Answer 2

Pants

bra

Question 3

What do you look for?

Answer 3

Skin
Cervical spine
Thoracolumbar spine

Question 4

What do you look for on inspection of the skin?

Answer 4

Cafe au lait spot (neurofibroma)
Sacral dimple, hairy dimple (spina bifida)
Scarring

Question 5

What should you feel for?

Answer 5

Tenderness in spine
Kneck (anterior, lateral, posterior)
Supraclavicular fossa
Paraspinal muscles
Sacrum
Sacroiliac joints

Question 6

What would tender sacroiliac joints suggest?

Answer 6

Ankylosing spodylitis

Question 7

What would a step at the lumbrosacral junction suggest?

Answer 7

Spondylolisthethis

Question 8

How do you assess active ROM of the cervical spine?

Answer 8

Chin should touch sternoclavicular joint
Extension to 50
Lateral flexion 45
Lateral rotation 80 both sides

Question 9

What should you do if there is restriction of ROM?

Answer 9

Cautiously assess passive ROM

Question 10

What should you assess for ROM of the thoracolumbar spine?

Answer 10

Touch the floor?
Schober's test
Extension
Lateral flexion
Rotation

Question 11

What is a normal distance to be away from the floor with fingers?

Answer 11

< 7cm

Question 12

What is Schober’s test?

Answer 12

Mark 15cm of lumbar spine (10cm above and 5cm below PSIS)
Flex spine maximally
5cm minimum increase in distance

Question 13

How do you assess extension of thoracolumbar spine?

Answer 13

Ask patient to arch back
thoracic = 25
lumbar = 35

Question 14

What does significant pain and restriction on arching back suggest?

Answer 14

Prolapsed disc

Spondylolysis

Question 15

How do you assess lateral flexion of the thoracolumbar spine?

Answer 15

Ask patient to flex to one side
Distance between fingers to floor should be >10cm
Equal contribution from lumbar and thoracic spine

Question 16

How do you assess rotation of the thoracolumbar spine?

Answer 16

Seat patient
Fold arms across chest
Twist to each side
40 degree rotation all thoracic

Question 17

What should you percuss?

Answer 17

Spine from root of neck to sacrum

Question 18

What does tenderness on percussion suggest?

Answer 18

Infection
Fracture
Neoplasia

Question 19

What else should you assess?

Answer 19

Gait

Question 20

What do you do if you suspect there is a prolapsed disc?

Answer 20

Straight leg raise
Ask patient to lie flat on couch
Passively flex extended leg
Back or leg pain is positive

Question 21

What does paraesthesia or nerve root distributed pain suggest when testing for a prolapsed disc?

Answer 21

Nerve root irritation

Question 22

What does back pain suggest when testing for a prolapsed disc?

Answer 22

Central disc prolapse

Question 23

What does leg pain suggest when testing for a prolapsed disc?

Answer 23

Lateral protrusion of disc

Question 24

What is Lasegue’s sign?

Answer 24

Gradually lower leg until pain dissapears, then dorsiflex the foot. Pain suggests nerve root irritation

Question 25

What is the Bowstring test?

Answer 25

Perform a straight leg raise
If pain felt, fkex knee then press into popliteal fossa with thumb
radiating pain and paraesthesia suggests nerve root irritation

Question 26

What is the femoral stretch test?

Answer 26

Patient lying prone
Anterior thigh fixed to couch
flex each knee in turn
Pain in skin of anterior thigh is positive for disc protrusion

Question 27

What do you do if you suspect ankylosing spondylitis?

Answer 27

Chest expansion at fourth intercostal space may be reduced

Question 28

What would you do to complete the exam?

Answer 28

Full neuro exam of limbs
Abdominal exam in lower back pain
Rectal exam for cauda equina
Peripheral pulses for claudication
Shoulder exam in neck pain
Hip exam in lower back pain

Question 29

How do you finish the exam?

Answer 29

Thank the patient
Ask to redress
Present