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Phase 2b Sheffield Medicine > Spine Examination > Flashcards

Spine Examination Flashcards

1
Q

What should you do before commencing with a spine examination?

A

● Wash your hands and don PPE if appropriate.
● Introduce yourself to the patient including your name and role.
● Confirm the patient’s name and date of birth.
● Briefly explain what the examination will involve using patient-friendly language.
● Gain consent to proceed with the examination.
● Adequately expose the patient’s upper body and provide a blanket to cover the patient when not being examined.
● Ask the patient if they have any pain before proceeding with the clinical examination.

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2
Q

What is the first step in a spine examination?

A

● General inspection looking for clinical signs and for objects/equipment.

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3
Q

What clinical signs should you look for when completing a general inspection during a spine exam?

A

● Body habitus
● Scars
● Wasting of muscles

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4
Q

What may body habitus be suggestive of when completing a general inspection during a spine exam?

A

● Obesity is a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis).

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5
Q

What may scars be suggestive of when completing a general inspection during a spine exam?

A

● May provide clues regarding previous spinal surgery.

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6
Q

What may wasting of muscles be suggestive of when completing a general inspection during a spine exam?

A

● Suggestive of disuse atrophy secondary to joint pathology

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7
Q

What objects or equipment may be seen when completing a general inspection during a spine exam?

A

● Aids and adaptations: examples include walking aids and wheelchairs.
● Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g. analgesia).

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8
Q

After completing a general inspection of the patient what is the next step in a spine exam?

A

● Closer inspection of the spine, asking the patient to turn in 90° increments as you inspect the spine from each angle for evidence of pathology.

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9
Q

What clinical signs may be observed on anterior inspection during a spine exam?

A

● Scars
● Posture
● Asymmetry of the shoulder girdle
● Pelvic tilt

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10
Q

What may a anterior neck scar suggest about spine pathology on a patient during anterior inspection of the spine?

A

● Anterior cervical discectomy

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11
Q

What may asymmetry of the shoulder girdle be suggestive of during anterior inspection of the spine?

A

● May be caused by scoliosis, arthritis, fractures or dislocation.

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12
Q

What clinical signs may be observed on lateral inspection during a spine exam?

A

● Cervical lordosis
● Thoracic kyphosis
● Lumbar lordosis

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13
Q

What may cervical hyperlordosis suggest when completing lateral inspection during a spine exam?

A

● Hyperlordosis is associated with chronic degenerative joint disease (e.g. osteoarthritis).

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14
Q

What may thoracic hyperkyphosis suggest when completing lateral inspection during a spine exam?

A

● The normal amount of thoracic kyphosis is typically between 20-45º. Hyperkyphosis is associated with Scheuermann’s disease (congenital wedging of the vertebrae).

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15
Q

What may lumbar hypolordosis suggest when completing lateral inspection during a spine exam?

A

● Loss of normal lumbar lordosis is associated with sacroiliac joint disease (e.g. ankylosing spondylitis).

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16
Q

What clinical signs may be observed on posterior inspection during a spine exam?

A

● Spinal alignment abnormalities
● Iliac crest alignment abnormalities
● Muscle weakness
● Abnormal hair growth
● Bruising

17
Q

What may spinal alignment abnormalities suggest on posterior inspection during a spine exam?

A

● Inspect for lateral curvature of the spine indicative of scoliosis.

18
Q

What may iliac crest alignment abnormalities suggest on posterior inspection during a spine exam?

A

● Misalignment may indicate a leg length discrepancy or hip abductor weakness.

19
Q

What may muscle wasting suggest on posterior inspection during a spine exam?

A

● Note any wasting of the paraspinal muscles which may indicate chronic spinal pathology and reduced mobility.

20
Q

What may abnormal hair growth indicate on posterior inspection during a spine exam?

A

● May indicate underlying bony abnormalities such as spina bifida.

21
Q

What clinical signs may be observed when asking a patient to walk during a spine exam?

A

● Gait cycle abnormalities
● Reduced range of movement
● Limping
● Leg length
● Turning
● Trendelenburg’s gait
● Waddling gait
● Assess the patient’s footwear

22
Q

Describe where you would need to palpate during the feel portion of a spine exam?

A

● Palpate the spinal processes and sacroiliac joints, assessing their alignment and noting any tenderness.
● Palpate the paraspinal muscles noting any tenderness or muscular spasms.

23
Q

What is active movement?

A

● Active movement refers to a movement performed independently by the patient.

24
Q

What is passive movement?

A

● Passive movement refers to a movement of the patient, controlled by the examiner.

25
Q

What movements should be performed to assess movement of the cervical spine?

A

● Flexion
● Extension
● Lateral flexion
● Rotation

26
Q

How would you ask a patient to perform flexion of the cervical spine?

A

● Ask the patient to touch their chin to their chest.

27
Q

What is the normal range of movement for flexion of the cervical spine?

A

● 0°- 80°

28
Q

How would you ask a patient to perform extension of the cervical spine?

A

● Ask the patient to look up at the ceiling.

29
Q

What is the normal range of movement for extension of the cervical spine?

A

● 0°- 50°

30
Q

How would you ask a patient to perform lateral flexion of the cervical spine?

A

● Ask the patient to touch their ear to their shoulder on each side.

31
Q

What is the normal range of movement for lateral flexion of the cervical spine?

A

● 0°- 45°

32
Q

How would you ask a patient to perform rotation of the cervical spine?

A

● Ask the patient to turn their head to the left and the right.

33
Q

What is the normal range of movement for rotation of the cervical spine?

A

● 0°- 80°

34
Q

What movements should be performed to assess movement of the lumbar spine?

A

● Flexion
● Extension
● Lateral flexion

35
Q

How would you ask a patient to perform flexion of the lumbar spine?

A

● Ask the patient to touch their toes whilst keeping their legs straight.

36
Q

How would you ask a patient to perform extension of the lumbar spine?

A

● Ask the patient to lean back as far as they are comfortably able, whilst you’re positioned close to them for support if required.

37
Q

What is the normal range of movement for extension of the lumbar spine?

A

● 10°- 20°

38
Q
A

Phase 2b Sheffield Medicine (17 decks)

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