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.
What movements should be performed to assess movement of the cervical spine?
● Flexion
● Extension
● Lateral flexion
● Rotation
How would you ask a patient to perform flexion of the cervical spine?
● Ask the patient to touch their chin to their chest.
What is the normal range of movement for flexion of the cervical spine?
● 0°- 80°
How would you ask a patient to perform extension of the cervical spine?
● Ask the patient to look up at the ceiling.
What is the normal range of movement for extension of the cervical spine?
● 0°- 50°
How would you ask a patient to perform lateral flexion of the cervical spine?
● Ask the patient to touch their ear to their shoulder on each side.
What is the normal range of movement for lateral flexion of the cervical spine?
● 0°- 45°
How would you ask a patient to perform rotation of the cervical spine?
● Ask the patient to turn their head to the left and the right.
What is the normal range of movement for rotation of the cervical spine?
● 0°- 80°
What movements should be performed to assess movement of the lumbar spine?
● Flexion
● Extension
● Lateral flexion
How would you ask a patient to perform flexion of the lumbar spine?
● Ask the patient to touch their toes whilst keeping their legs straight.
How would you ask a patient to perform extension of the lumbar spine?
● Ask the patient to lean back as far as they are comfortably able, whilst you’re positioned close to them for support if required.
What is the normal range of movement for extension of the lumbar spine?
● 10°- 20°
