Examination: Spine

There are 6 main concepts that need to be remembered for ALL of the regional examination of the musculoskeletal system:

  1. Position always position your patient as you would like to examine them before you begin
  2. Look inspect and observe the patient and around the patient's bedside
  3. Feel for example, feeling a joint to see if it is hot or swollen
  4. Move actively (the patient moves the joint) then passively (you do the movements for them)
  5. Function can the patient move their joints in order to complete day to day tasks?
  6. Special tests if applicable

  • Wash hands
  • Introduce yourself
  • Ask permission to examine the relevant part of the body
  • Expose the patient ideally in underwear only, at least exposing the joint of interest and the joints above and below this
  • Reposition the patient standing up at first

Position:
  • Patient standing up

Look:
  • Front, sides and back
  • For normal cervical lordosis, thoracic kyphosis and lumbar lordosis
  • For scholiosis
  • Question mark sign in Ankylosing Spondilitis

Feel:
  • The spine of each vertebra
  • The paravertebral muscles
  • The sacroiliac joints

Move:
  • Actively:
    • Ask patient to touch their toes as you put two fingers on 2 vertebrae. They should significantly move apart as the patient bends forward.
    • Assess lateral flexion
    • Assess cervical movements:
    • Touch ear to shoulder (lateral flexion)
    • Look up (extension)
    • Look down (flexion)
    • Look left (rotation)
    • Look right (rotation)
  • Passively:
    • Ask patient to sit down and cross arms
    • Rotate the patient's torso to look left and right - assesses thoracic rotation

Function:
  • Already assessed

Special testing:
  • Stretch test:
    • Ask patient to lie town. Lift up a straight leg and dorsiflex the foot. This may exacerbate pain from a nerve root entrapment or irritation

To conclude the examination:
  • Thank the patient
  • Tell them they can get dressed now
  • Offer to examine the joint above and the joint below
  • Consider neurological examination of the limb examined



The complete examination of the musculoskeletal system includes:


written by: celine_lakra, first posted on: 09/01/12, 22:17

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Comments:

Katep says...
A good special test for Ankylosing Spondylitis:
Schober's Index: measures lumbar spine mobility
Mark central point between posterior superior iliac spines (dimples in lower back)
Measure 10cm above and 5cm below PSIS (15cm in total)
Ask pt to bend forward as far as possible with their feet hip-width apart and not bend their knees
Measure the distance again
The distance should increase by >5cm (to >20cm)
<5cm is of concern (Ankylosing Spondylitis)
POSTED ON: 12/01/14, 12:50
joel_cunningham says...
Great addition, thanks KateP!
POSTED ON: 12/01/14, 15:29
says...
In "look", is normal not a cervical lordosis, thoracic kyphosis and lumbar lordosis?
POSTED ON: 09/05/14, 14:12
Joel_cunningham says...
Thanks for pointing out the typo - lordosis and kyphosis have been put back into their normal position!

To clarify:
Cervical spine normally has an element of lordosis
Thoracic spine normally has an element of kyphosis
Lumbar spine normally has an element of lordosis

All of these can been exagerated or removed by pathological processes (such as crush fractures, degeneration, etc.)

BW,

Joel
POSTED ON: 08/03/16, 12:40

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