Spine examination

Question 1

In the spine examination, what do we GENERALLY INSPECT?

Answer 1

Surrounding area:
Walking aid
Specialist shoe

Patient:
Signs of discomfort
Systemically well
Body habitus

Question 2

In the spine examination, what do we LOOK for?

Answer 2

Gait:
Antalgic
Trendelenburg
High stepping associated with foot drop
Stiff hip

Inspect:
Overall alignment and willingness to weight bear
Deformity - normal kyphosis and lordosis? scoliosis? question mark posture (ankylosing spondylitis)?
Scars - spine surgery
Wasting - para spinal and gluteal muscle
Swelling
Skin changes - erythema, bruising

Question 3

In the spine examination, what do we FEEL for?

Answer 3

Spinous processes of each vertebra from cervical to sacrum - tenderness on palpation?

Sacroiliac joint - tenderness on palpation?

Para spinal, trapezius, and intrascapular muscles - tenderness on palpation?

Question 4

In the spine examination, what MOVEMENTS do we assess?

Answer 4

Cervical spine:
Flexion, extension, rotation, lateral flexion

Lumbar spine:
Flexion (2 fingers on spine and see for increase in gap), extension, lateral flexion (hands slide down leg)

Thoracic spine (sat and supine)
Rotation, chest expansion

Question 5

In the spine examination, what SPECIAL TESTS do we perform?

Answer 5

Nerve root compression test:
Straight leg raise test - look for pain in lower back, buttock or leg when raised to 30-70degs. Pain suggests disc herniation at L4, L5, S1
Femoral stretch test - look for pain in lower back, buttock or leg. Pain suggests femoral nerve irritation due to L2, L3, L4 compression

Schober’s test - lumbar flexion

Wall test - to see if there is increased kyphosis

Question 6

In the spine examination, what JOINT ABOVE do we test?

Answer 6

Hip:

Internal rotation in flexion

Question 7

In the spine examination, what NEUROVASCULATURE do we test?

Answer 7

Power:
Hip flexion (femoral nerve) and extension (gluteal nerve)
Knee flexion (sciatic nerve) and extension (femoral nerve)
Dorsiflexion (common peroneal nerve) and plantar flexion (tibial nerve)
Toe flexion (tibial nerve) and extension (common peroneal nerve)

Reflexes:
Knee and ankle

Sensation:
All dermatomes of lower limbs

Vascular:
Posterior tibial and dorsalis pedis