What - Spine

Question 1

Specifically looks for excessive kyphosis, lordosis and scoliosis or other deformity (with adequate exposure)
1. What are the definitions of these terms?

Answer 1

Kyphosis - a normal curvature of the spine where the curve is convex posteriorly. It occurs in the thoracic & sacral
regions.
Lordosis - the normal curvature of the spine where the curve is convex anteriorly. It occurs in the lumbar & cervical
regions.
Scoliosis - a medical condition in which a person’s spine has a sideways curve i.e. the curves are in the medial/lateral
directions. The curve is usually “S”- or “C”-shaped. In some, the degree of curvature is stable, while in others it increases
over time. Mild scoliosis does not typically cause problems, while severe cases can interfere with breathing

Question 2

2. What is usually the most prominent spinous process in the upper spine?

Answer 2

The most prominent spinous process in the upper spine is usually T1, so that C7 is the next one felt above that (useful
landmark).

Question 3

3. What movements are most affected in cervical spondylosis?

Answer 3

Rotation is usually restricted and painful in cervical spondylosis

Question 4

Measures occiput to wall distance
4. What is the normal distance for occiput to wall?

Answer 4

4. Normal distance for occiput to wall is usually zero centimetres (or whatever unit using)

Question 5

With the patient sitting, palpates the spinous processes and paraspinal muscles in the thoracic spine
5. What level is the inferior angle of the scapula?

Answer 5

5. The inferior angle of the scapula is opposite the spinous process of T 7

Question 6

Assesses range of rotational movement in the thoracic spine whilst sitting (forward flexion and lateral movement assessed
once standing again)
6. What causes kyphosis in young people? In much older people?

Answer 6

Kyphosis in young people is often caused by the inflammatory condition Scheuermann’s disease; however, in older
people it is usually caused by degenerative disease and osteoporosis (widow’s hump)

Question 7

With the patient lying prone or standing, palpates the spinous processes and paraspinal muscles in the lumbar spine
7. What level are the top of the iliac crests?

Answer 7

The top of the iliac crests lie opposite the L4 spinous process or the L4-5 intervertebral disc.

Question 8

Assesses range of movement in the lumbar spine
8. What causes increased lumbar lordosis? Decreased lumbar lordosis?
9. What lordosis may occur with a prolapsed intervertebral disc?

Answer 8

8. Increased lumbar lordosis may be a normal finding in females, or in pregnancy, truncal obesity or spondylolisthesis (is a
   condition in which one vertebra slides forward over the bone below it. Spondylolisthesis most often occurs in the lower
   spine (lumbosacral area). In some cases, this may cause spinal cord or nerve root compression.
9. Decreased lumbar lordosis may occur in prolapsed intervertebral disc or with degenerative disease

Question 9

Performs the modified Schober test
10. What movement does the modified Schober test consider?

Answer 9

The modified Schober test assesses lumbar flexion and it is normally at least an increase of 5cm.

Question 10

With the patient lying, performs straight leg raising test and crossed straight leg raise.
11. What is considered a positive straight-leg raising test? What does it mean?
12. How is it different to a crossed straight leg raise test?

Answer 10

11. The straight-leg raising, or Lasegue sign, is considered positive when pain (the pain that the patient has been getting,
    not hamstring tightness!) is experienced whilst the leg is elevated between 30 and 70 degrees. Pain below 30 degrees is
    not considered due to nerve root irritation. It can mean the patient has a lumbar radiculopathy due to disc herniation.
12. With patient lying supine, take the heel of the foot on the opposite side to that affected by pain, and lift the straight leg
    from the consult bed. The test is positive when the leg is elevated between 30 and 70 degrees and pain is produced
    down the posterior thigh below the knee on the opposite side to the leg that has been lifted. It can mean the patient
    has a lumbar radiculopathy due to disc herniation.

Question 11

Assesses L5 and S1 nerve roots by asking patient to walk on heels and walk on toes (covered in Lower Limb Neurology)
13. What should you also do if a patient is unable to do these movements due to loss of power?

Answer 11

13. When a patient is unable to or finds it difficult to walk on heels and toes, due to weakness, you must also test
    neurologically for:
    a. sensory loss (dermatomes, peripheral nerves, pain and temp, light touch, pain and vibration)
    b. presence of reflexes (L3-4 knee jerk, S1 ankle jerk)
    c. coordination (specific tests can be done)