8/9/2019 Spinal Examination

1/4

Spinal examination  Print this Page

HISTORY

It is important to bear in mind the following points when performing a spinal examination:

•  Age of the patient

o Younger patients - instability is more common

o Older patients - osteoarthritis is more prevalent

• Mechanism of inury

• !haracter of symptoms

o "ocalised pain - trauma# infection# tumour

o Mechanical pain - instability

o $adicular pain - herniated disc

• Onset of symptoms

•  Areas of numbness %saddle anaesthesia&

• 'ladder or bowel incontinence %!auda ()uina syndrome&

• "eg pain

CLINICAL EXAMINATION

Follow the scheme below

• Inspection

• Palpation

• Measurement

• Movement

!e"o#e sta#tin$

• Introduce yourself

•  As* permission to perform examination

• (xplain what the examination entails

• (xpose the patient appropriately - the patient should undress to their undergarments including the

lower limbs+

• ,ell the patient to let you *now if anything you do is uncomfortable

• $emember - always watch the patients face

Inspection

• eneral observation

o .oes the patient loo* well/o  Assess the patient0s posture - any obvious conditions/

Patient Standing 

$emember to inspect from all sides %front# laterally and from behind&:

• 1*in

o 1cars %surgical scars&

http://window.print%28%29/http://window.print%28%29/

8/9/2019 Spinal Examination

2/4

o 1inuses %deep infection&

o 2nusual s*in creases

o Pigmentation

!afe au lait spots %3eurofibromatosis&

4airy patch %spinal dysraphism&

Mongolian 'lue spot %no clinical significance - more common in asians&

•1pine

o 5yphosis %exaggerated or reduced&

o "umbar lordosis %exaggerated or reduced&

o 1coliosis %asymmetry of shoulder height 6 trun* balance 6 loin crease&

o "ist % may be sign of prolapsed intervetrbral disc causing nerve root irritation&

•  Asymmetry of the pelvis %leg length discrepancy&

•  Any chest deformity

,he wall test will mas* even small fixed flexion deformities: As* the patient to stand with the bac* straightagainst a wall+ Observe whether the following are in contact with the wall:

• Occiput

• 1houlders

• 'uttoc*s

• 4eels

Patient Walking 

• Observe the gait

%alpation

 As* the patient+++7.oes it hurt anywhere/7

• Palpate for tenderness

o 1pinous processes - starting from cervical spine to the sacrum

o 8acet oints

o Interspinous ligaments

o 1acroiliac oints

• !hec* if there is a step or bony prominence %1pondylolisthesis# fracture&

• 1pasm - paravertbral muscles

Measement

1chober0s test

,his is a test to determine the amount of lumbar flexion+

•  A mar* %with a water-soluble pen& is made 9cm superior and ;cm below the .imples of

8/9/2019 Spinal Examination

3/4

!hest (xpansion

• Measue chest expansion %should measure >cm between full inspiration and full expiration&

Mo'ements

,his should be done actively+

!ervical 1pine

• 8lexion - 7!an you bring your chin to your chest/7 %8ix both shoulders to ensure movement

obtained is from the cevical spine&

• (xtension - 7!an you loo* at the ceiling/7

• "ateral flexion - 7!an you bring your right ear to you right shoulder/7 $epeat for both sides

%movement restricted in arthritis&

• "ateral rotation - 7!an you loo* over your shoulder for me/7 $epeat for both sides

,horacic spine

• $otation - 7!an you twist at the waist for me/7 $epeat for both sides % 8ix the pelvis - either by

as*ing the patient to sit down or stabilising the pelvis with both hands+ "oo* for asymmetry&

"umbar 1pine

• 8lexion - 7!an you touch your toes/7 %Ma*e sure that there is no flexion at the *nees or hips&

o ,his would be a good time to test for scoliosis+

o 8orward 'end test - flexion should accentuate any scoliosis by causing a rib prominence

%hump& on the convexity of the curve and a loin crease on its concavity

If the scoliosis disappears on forwards bending - postural

If the scoliosis disappears on sitting - it may be due to leg shortening

• (xtension - 7!an you arch bac*wards/7 %ma*e sure the *nees are *ept straight&

• "ateral flexion - 7!an you run your hand down your thigh/7 $epeat for both sides %Asymmetry inrange of movement is clinically more significant than actual range of movement&

Special Tests

1traight "eg $aise %1"$&

,his is a test for sciatic nerve root irritation

• ?ith the *nee extended# passively flex the hip by lifting the heel off the examination couch and

estimate the angle of elevation

• Movement restricted as a result of pain radiating from the bac* to '("O? the *nee %i+e+ bac*#

buttoc*# thigh and calf& is suggestive of sciatic nerve root irritation+

• !oncomitant dosiflexion of the an*le can cause an increase in pain %'ragard0s ,est&

'owstring ,est

,est for nerve root irritation

• ?ith the hip flexed to @ degrees# extend the *nee as much as possible

• Pain elicited upon the application of pressure to the hamstrings is suggestive of nerve root irritation

8/9/2019 Spinal Examination

4/4

8emoral  3erve 1tretch test

,est =nd# rd and Bth "umbar root irritation

• ?ith the patient lying on his side and the hip extended# flex the ipsilateral *nee and as* the patient

whether they feel any pain+ Also as* for the location and radiation of the pain+

•1evere anterior thigh pain is suggestive of second# third and fourth lumbar root irritation

Finall(

• !hec* for distal neurovascular supply+

• !hec* reflexes - *nee and an*le er*s# plantars+

• Perform a P$ examintion:

o In trauma cases

o If there is any perianal sensory changes

o  Any bladder or bowel symptoms

o If there are any upper motor neurone signs