Download Introduction to spinal examination

Introduction to spinal examination
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Wash hands
Introduce yourself
Confirm patient details – name / DOB
Explain examination
Gain consent
Expose patient’s upper body
Position patient standing
Ask if the patient currently has any pain
Look
Look for aids and adaptations – walking stick / wheelchair
Inspect patient from all angles
Front
Posture of head and neck – symmetry / abnormal position
Symmetry of shoulders – note any misalignment
Side
Cervical lordosis – assess for hyper-lordosis – spondylolisthesis / osteoporosis / discitis
Thoracic kyphosis – normal is 20-45º – hyperkyphosis (>45º) – vertebral fracture
Lumbar lordosis – assess for hyperlordosis – obesity / tight lower back muscles
Behind
Scars – can provide clues as to previous surgery / trauma
Wasting – paraspinal muscles / back muscles – may suggest chronic immobility
Scoliosis – lateral curvature of the spine – resembles an “S” shape
Abnormal hair growth – spina bifida
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Inspect from the front.
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Inspect the curvature of the cervical spine.
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Inspect the curvature of the thoracic spine.
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Inspect the curvature of the lumbar spine.
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Inspect the spine posteriorly for evidence of scoliosis.
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Feel
Palpate spinal processes and sacroiliac joints – assess for tenderness and alignment
Palpate paraspinal muscles – note any tenderness or muscle spasms
Observe the patient’s face as you perform the above, looking for signs of pain.
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Palpate the spinal processes to assess alignment and detect any tenderness.
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Palpate the spinal processes to assess alignment and detect any tenderness.
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Palpate the spinal processes to assess alignment and detect any tenderness.
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Palpate the sacroiliac joints for tenderness.
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Palpate the paraspinal muscles for evidence of spasm or tenderness.
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Move
Cervical spine
Assess active movements:
Flexion – “touch your chin to your chest” – normal ROM 0-80º
Extension – “look up at the ceiling” – normal ROM 0-50º
Lateral flexion – “touch your ear to your shoulder” – normal ROM 0-45º
Rotation – “turn your head to the left and then to the right” – normal ROM 0-80º
Perform passive movements if reduced ROM on active movement.
Assess if pain/stiffness/muscle spasm is the restricting factor.
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Assess Cervical flexion.
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Assess Cervical extension.
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Assess Cervical rotation.
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Assess Lateral Flexion of the Cervical Spine.
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Lumbar spine
Assess active movements:
Flexion – “touch your toes, keeping your legs straight”
Extension -“lean backwards as far as possible” – normal ROM 10-20º
Lateral flexion – “slide your left hand down the outer aspect of your left leg as far as possible, keeping your legs
straight” – repeat the test using the right hand/leg
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Assess Lumbar Flexion.
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Assess Lumbar Extension.
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Assess Lateral Lumbar Flexion.
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Thoracic spine
Thoracic rotation– sit the patient down, with arms crossed across chest and ask to turn side to side
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Assess Thoracic Rotation.
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Special tests
Schober’s test – tests the range of motion in the lumbar spine
1. Identify position of the posterior superior iliac spine (PSIS) – “dimples of Venus”
2. Mark the skin in the midline 5cm below PSIS
3. Mark the skin in the midline 10cm above PSIS
4. Ask the patient to touch their toes – full lumbar flexion
5. Measure the distance between the two lines (started at 15cm)
Normally the distance between the two marks should increase to >20cm.
Reduced range of motion can indicate conditions such as ankylosing spondylitis.
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Mark the midline at the level of the posterior superior iliac spines.
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Draw 2 further marks, 10cm above and 5cm below.
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Ask patient to keep their legs straight and touch their toes.
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Measure the distance between the most superior and inferior marks. It should normally increase from 15cm to more than 20cm
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Sciatic stretch test – (straight leg raise)
1. Position the patient supine on the bed
2. Holding the ankle, raise the leg (passively flexing the hip) – keeping the knee straight
3. Normal ROM is approximately 80-90º of passive hip flexion
4. Once the hip is flexed as far as the patient is able, dorsiflex the foot
5. The test is positive if the patient experiences pain in the posterior thigh / buttock
If this causes pain in lower back /thigh/ buttocks, it suggests sciatic nerve root impingement
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Raise the straight leg upwards as far is the patient is able to.
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Passively dorsiflex the foot. Pain in the posterior thigh / buttock would be considered a positive test result.
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Femoral nerve stretch test
1. Position the patient prone
2. Flex the knee
3. Extend the hip
4. Plantar-flex the foot
Positive test = pain felt in thigh/ inguinal region.
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With the patient prone elevate the thigh with the knee flexed. Pain in the anterior thigh / inguinal region is considered a positive
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To complete the examination
Thank patient
Wash hands
Summarise findings