Thoracic and lumbar spine examination

Question 1

look at skin

Answer 1

erythema

scars

Question 2

look at soft tissue

Answer 2

swelling
bruising
rash
muscle wasting
hairy patch covering congenital abnormality

Question 3

look at bone

Answer 3

rib hump

abnormal curvature eg scoliosis

Question 4

feel skin

Answer 4

temp

Question 5

feel soft tissue

Answer 5

tenderness paraspinal muscles thoracic/lumbar spine

Question 6

feel bone

Answer 6

mid-line spinous processes from 1st thoracic vertebrae to 5th lumbar vertebra - check for bone alignment and tenderness.
Iliac crests at 4/5th lumbar intervertebral space

Question 7

move active and passive movement

Answer 7

ROM - active
Thoracic spine - rotation to right and left sides
Lumbar spine - flexion, extension and lateral flexion to each side

Question 8

special tests

Answer 8

Schober’s test
Straight leg raise
Wall test

Question 9

Schober’s test

Answer 9

assesses movement in the lower lumbar spine. Place a finger on the patients skin centrally over the 5th lumbar vertebra. Two other marks are made, 10cm and 5cm below this point. So two marks are 15cm apart.

Question 10

Straight leg raise SLR

Answer 10

Lift each of pt’s outstretched legs off the bed to assess if pain is reproduced in the distribution of the sciatic nerve with pt supine and knees extended
If shooting pain down the back of the leg = radiculopathy/ possible impingement of sciatic nerve

Question 11

Wall test

Answer 11

pt stand against a flat wall
examiner tries to slide hand between lumbar spine and the wall.
If excessive lumbar lordosis, entire hand/arm may be able to fit in this space

Question 12

Do — exam of both lower limbs

Answer 12

neurological