Spine Exam

Question 1

Introduction

Answer 1

• Infection control, introduce self, identify patient
• Explanation, consent, check for discomfort
• Adequately expose spine

Question 2

Inspection

Answer 2

• From behind - position of head, position of neck, position of shoulders, thoraco-lumbar scoliosis (standing and bending forward)
• From the side - cervical lordosis, thoracic kyphosis (+/- gibbus), lumbar lordosis

Question 3

Palpation

Answer 3

• Supraclavicular region - cervical ribs, lymphadenopathy
• Mid-line - cervical to lumbar spinous processes
• Paraspinal muscles (muscle bulk, spasm)
• Iliac crest heights (asymmetry, pelvic tilt)
• Sacroiliac joints
• Chest expansion if ankylosing spondylitis suspected

Question 4

Move (active)

Answer 4

Cervical spine :
- flexion - “chin to chest” - look from side
- extension “lift chin as far as possible”- look from side
- lateral flexion - “ear to shoulder” - look from behind
- rotation - “look over each shoulder” - look from above
Note - hold down on shoulders to reduce compensatory shoulder movement in lat flex and to reduce thoracic rotation in rotational movement

Lumbar spine :
- flexion (Schober’s test) - look from side
- extension - look from side - ask about discomfort
- lateral flexion - “bend to each side and slide hand down leg as far as possible,” compare sides - look from behind

Question 5

Special tests

Answer 5

• Schober’s test to assess lumbar flexion if ankylosing spondylitis suspected
• Straight leg raise if nerve root irritation was suspected

Question 6

Schober’s test

Answer 6

• With the patient standing and facing away from you, find the level posterior superior iliac spines
• Identify (with a finger or mark) POINT A 10cm above this level and POINT B 5cm below this level in the midline.
• Hold the tape measure at point A and let it dangle down to point B (where it should read 15cm). Now ask the patient to flex/lean forward as if trying to touch their toes and observe the new length between point A and B.
• Normal flexion is represented as >20cm between point A and B.
• Less than this represents limited flexion, such as may be found in ankylosing spondylitis.

Question 7

Closure

Answer 7

• Explanation and appropriate documentation of findings
• Thank patient, infection control