MSK Examination - Spine

Question 1

First thing?

Answer 1

Intro and end of bed examination

Question 2

Look.

Answer 2

Observe spine from side to look for normal spinal curves, are they increased/decreased?

Observe spine from behind looking at the posture of the neck/head - is it straight, symmetrical

Any scoliosis? (sideways)

Any scars, sinuses or swellings

Question 3

What are the normal curves of the spine?

Answer 3

Cervical - lordotic (inwards)
Thoracic - kyphotic (outwards)
Lumbar - lordotic

Question 4

Feel - what to say to patient before starting?

Answer 4

Ask about pain

“going to feel all down your spine, please let me know if anywhere is tender or painful”

Question 5

Feel - what we looking for?

Answer 5

Palpate the midline spinous processes from top to bottom
Feel the sacroiliac joints (bottom most part)
Feel for paraspinal muscle tenderness or increased tone one side at a time (muscles to side of spine)

Question 6

Describe the active movements of the cervical spine and also how many degrees from neutral patient should move normally

Answer 6

Flexion - patient puts chin on chest - 80* from neutral
Extension - tilt head back with care - 50* from neutral
Lateral flexion - ear to shoulders - 45* from neutral
Rotation - look over both shoulders - 80* from neutral

Question 7

Active movements of the lumbar spine?

Answer 7

Flexion - touch toes while you place two fingers on two lumbar spinous processes to measure

Extension - bend back

Lateral flexion - patient bends to one side with their hand on side

Question 8

Active movements of the thoracic spine?

Answer 8

Sit them down
Cross arms in an X
Ask them to turn right and left while guiding from shoulders

Question 9

NEUROLOGICAL EXAM - first thing you would do?

Answer 9

Ask patient to lie down
Lift patients leg to point of pain, then put leg right below this point and dorsiflex the ankle. May exacerbate the pain from a nerve root entrapment.