Spine Examination Flashcards
State the 9 stages of the spine examination
- Introduction
- General inspection
- Closer inspection
- Gait
- Feel
- Move
- Special tests
- Completing the examination
How do you want your pt exposed for spine examination?
- Upper body exposed
What should you do in the introduction stage of your spine examination?
- Wash hands
- Introduce yourself
- Gain consent
- Ask if want chaperon
- Ask if in any pain
- Expose
- Position
What should you do in the general inspection stage of your spine examination?
General Inspection of pt
- Body habitus
- Scars
- Posture
- Wasting of muscles
General inspection of surroundings
- Walking aids
- Prescriptions
- Braces etc..
- Heat packs
What should you do in the closer inspection stage of your spine examination?
Ask pt to turn in 90 degree increments
Anterior inspection
- Scars
- Posture
- Asymmetry shoulder girlde
- Pelvic tilt
Lateral inspection
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
Posterior inspection
- Spinal alignment/scoliosis
- Iliac crest alignment
- Muscle wasting
- Abnormal hair growth e.g. spina bifida
- Brusising
- Scars
What should you do in the gait stage of your spine examination?
Ask pt to walk to end of room and turn around. Observe:
- Gait cycle
- ROM
- Limping
- Leg length discrepancy
- Turning
- Gait type
- Assess footwear
What should you do in the feel stage of your spine examination?
Palpate:
- Spinal processes
- Sacroiliac joints (alignment & tenderness)
- Paraspinal muscles (tenderness or muscle spasms)
What should you do in the move stage of your spinal examination?
Active movements
- C spine
- Flexion of C spine
- Extension of C spine
- Lateral flexion of C spine
- Rotation of C spine
- Lumbar spine
- Flexion of L spine
- Extension of L spine
- Lateral flexion of L spine
- Thoracic spine
- Rotation (ask to sit on edge of coach, corss arms, and turn L and R as far as comfortable)
What should you do in the special tests stage of your spine examination?
- Schober’s test
- Straight leg raise test
- Femoral nerve stretch test
Describe how to do Schobers test
Used to identify restricted flexion of lumbar spine which can occur in ankylosying spondylitis:
- Identify PSIS on each side
- Mark skin 5cm below PSIS
- Mark skin 10cm above PSIS
- Ask pt to touch toes
- Measure distance between two lines
Should show distance >20cm. If not, there is restricted lumbar flexion
Describe how to do the straight leg raise test
- Supine on coach
- Hold pts ankle, raise their leg passively whilst keeping their knee fully extended
- Once hip is flexed can dorsiflex ankle
Pain in posterior thigh or buttock indicates sciatic nerve irritation secondary to lumbar disc prolapse
Describe how to do the femoral nerve stretch test
Used to identify any femoral nerve irritation
- Position pt prone
- Flex knee to 90 degrees
- Then extend hip joint
- Finally plantar flex foot
Positive test if experience pain in thigh and/or inguinal region; suggests femoral nerve impingement.
What should you do in the completing your examination stage of the spine examination?
- Thank pt
- Dispose of PPE and was hands
- Summarise findings
- Further assessments & investigations
- Neurovascular exam of upper & lower limb
- Examination of hip & shoulder
- Further imaging (X-ray, MRI)
