Spine examination

Question 1

look

Answer 1

From behind:
Posture of head, neck and shoulders Thoraco-lumbar scoliosis (standing, bending forward)

From the side:
Cervical lordosis
Thoracic kyphosis (+/- gibbus) Lumbar lordosis

Question 2

feel

Answer 2

Supraclavicular – feel for cervical ribs or enlarged lymph nodes

Mid-line – spinous processes (cervical to lumbar vertebrae)

Para-spinal muscles (muscle bulk and note any spasm)

Iliac crest heights (asymmetry or excessive pelvic tilt)

Sacroiliac joints

Chest expansion (if ankylosing spondylitis suspected)

Question 3

move

Answer 3

Cervical spine:
Flexion
Extension
Lateral flexion (left and right)
Rotation (left and right, preferably with patient sitting so can be observed from above)

Lumbar spine:
Flexion
Extension
Lateral flexion (left and right)

Question 4

what is schobers test

Answer 4

with the patient standing and facing away from you, identify the level of the posterior superior iliac spines, with a finger or mark.
Identify 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.