Spine Examination Flashcards
What should you do before commencing with a spine examination?
● 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.
What is the first step in a spine examination?
● General inspection looking for clinical signs and for objects/equipment.
What clinical signs should you look for when completing a general inspection during a spine exam?
● Body habitus
● Scars
● Wasting of muscles
What may body habitus be suggestive of when completing a general inspection during a spine exam?
● Obesity is a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis).
What may scars be suggestive of when completing a general inspection during a spine exam?
● May provide clues regarding previous spinal surgery.
What may wasting of muscles be suggestive of when completing a general inspection during a spine exam?
● Suggestive of disuse atrophy secondary to joint pathology
What objects or equipment may be seen when completing a general inspection during a spine exam?
● 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).
After completing a general inspection of the patient what is the next step in a spine exam?
● 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.
What clinical signs may be observed on anterior inspection during a spine exam?
● Scars
● Posture
● Asymmetry of the shoulder girdle
● Pelvic tilt
What may a anterior neck scar suggest about spine pathology on a patient during anterior inspection of the spine?
● Anterior cervical discectomy
What may asymmetry of the shoulder girdle be suggestive of during anterior inspection of the spine?
● May be caused by scoliosis, arthritis, fractures or dislocation.
What clinical signs may be observed on lateral inspection during a spine exam?
● Cervical lordosis
● Thoracic kyphosis
● Lumbar lordosis
What may cervical hyperlordosis suggest when completing lateral inspection during a spine exam?
● Hyperlordosis is associated with chronic degenerative joint disease (e.g. osteoarthritis).
What may thoracic hyperkyphosis suggest when completing lateral inspection during a spine exam?
● The normal amount of thoracic kyphosis is typically between 20-45º. Hyperkyphosis is associated with Scheuermann’s disease (congenital wedging of the vertebrae).
What may lumbar hypolordosis suggest when completing lateral inspection during a spine exam?
● Loss of normal lumbar lordosis is associated with sacroiliac joint disease (e.g. ankylosing spondylitis).
What clinical signs may be observed on posterior inspection during a spine exam?
● Spinal alignment abnormalities
● Iliac crest alignment abnormalities
● Muscle weakness
● Abnormal hair growth
● Bruising
What may spinal alignment abnormalities suggest on posterior inspection during a spine exam?
● Inspect for lateral curvature of the spine indicative of scoliosis.
What may iliac crest alignment abnormalities suggest on posterior inspection during a spine exam?
● Misalignment may indicate a leg length discrepancy or hip abductor weakness.
What may muscle wasting suggest on posterior inspection during a spine exam?
● Note any wasting of the paraspinal muscles which may indicate chronic spinal pathology and reduced mobility.
What may abnormal hair growth indicate on posterior inspection during a spine exam?
● May indicate underlying bony abnormalities such as spina bifida.
What clinical signs may be observed when asking a patient to walk during a spine exam?
● Gait cycle abnormalities
● Reduced range of movement
● Limping
● Leg length
● Turning
● Trendelenburg’s gait
● Waddling gait
● Assess the patient’s footwear
Describe where you would need to palpate during the feel portion of a spine exam?
● Palpate the spinal processes and sacroiliac joints, assessing their alignment and noting any tenderness.
● Palpate the paraspinal muscles noting any tenderness or muscular spasms.
What is active movement?
● Active movement refers to a movement performed independently by the patient.
What is passive movement?
● Passive movement refers to a movement of the patient, controlled by the examiner.
