Spine examination signs

Question 1

What clinical signs are you looking for?

Answer 1

• body habitus: obesity if a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis)
• scars: may provide clues regarding previous spinal surgery
• wasting of muscles: suggestive of disease atrophy secondary to joint pathology

Question 2

What are you looking for in an anterior inspection of the spine?

Answer 2

• scars
• posture: ?asymmetry which may indicate joint pathology or scoliosis
• asymmetry of the shoulder girdle: ? scoliosis, arthritis, fractures or dislocation
• pelvic tilt: lateral pelvic tilt can be caused by scoliosis, leg length discrepancy or hip abductor weakness

Question 3

What are you looking for in a lateral inspection of the spine?

Answer 3

• Cervical lordosis: hyperlordosis is associated with chronic degenerative joint disease (e.g. osteoarthritis)
• thoracic kyphosis: the normal amount of thoracic kyphosis is typically between 20-45 degrees. Hyperkyphosis is associated with Scheuermann’s disease (congenital wedging of the vertebrae)
• lumbar lordosis: loss of normal lumbar lordosis is associated with sacroiliac joint disease (e.g. ankylosing spondylitis)

Question 4

What are you looking for in the posterior inspection of the spine?

Answer 4

• spinal alignment: inspect for lateral curvature of the spine indicative of scoliosis
• iliac crest alignment: misalignment may indicate a leg length discrepancy or hip abductor weakness
• muscle wasting: note any wasting of the paraspinal muscles which may indicate chronic spinal pathology and reduced mobility
• abnormal hair growth: may indicate underlying bony abnormalities such as spina bifida
• bruising: suggestive of recent trauma or surgery

Question 5

What are you looking for when observing the gait?

Answer 5

• gait cycle
• range of movement ( often reduced in the context of chronic joint pathology (e.g. osteoarthritis, inflammatory arthritis)
• limping
• leg length
• turning
• trendelenburg’s gait (an abnormal gait caused by bilateral weakness of the hip abductor muscles, typically associated with myopathies (e.g. muscular dystrophy)
• assess the patient’s footwear (unequal sole wearing is suggestive of an abnormal gait

Question 6

What can Schober’s test be used to identify?

Answer 6

Restricted flexion of the lumbar spine, which may occur in conditions such as ankylosing spondylitis

Question 7

What is the sciatic stretch test used to identify?

Answer 7

Sciatic nerve irritation (e.g. secondary to lumbar disc prolapse)
It is considered positive if the patient experiences pain in the posterior thigh or buttock region

Question 8

What is the femoral nerve stretch test used to identify?

Answer 8

Femoral nerve irritation

It is considered positive if the patient experiences pain in the thigh and/or inguinal region