REMS: Spine

Question 1

LooK

Answer 1

Observe the patients spine standing from behind and inspect for:

1. ​muscle wasting
2. asymetry
3. Scoliosis
4. Scars
5. Erythema
6. hairy patches

Observe the patients curvature viewing from the side

Question 2

Muscle wasting

Answer 2

Seen in spinal muscular atrophy

Question 3

Scoliosis

Answer 3

An abnormal lateral curvature of the spine. The causes of this can be congenital, idiopathic or secondary to neuromuscular diseases, such as spina bifida

Question 4

Hairy patches

Answer 4

Spina Bifida

Question 5

Normal curvature of the spine

Answer 5

S- shaped with:

• cervical lordosis
• thoracic kyphosis
• lumbar lordosis

Question 6

Feel

Answer 6

1. Palpate the spinal processess and over the sacroiliac joints with the patient standing and lying prone
2. palpate the paraspinal muscles

Note remember to observe the patients face for tenderness

Question 7

Move

Answer 7

Lumbar spine

with the patient standin, assess:

• Lumbar flexion- Place two finger over the patients lumbar spine and ask the patient to bend to touch their toes. On lumbar flexion the distance between two fingers should increase. Normal 15cm
• lateral flexion- ask patient to run hand down the outside of the adjacent leg

Thoracic spine

With the patient sitting

• thoracic rotation - patient sitting on the edge of the couch with their arms crossed, ask them to twist round both ways in order to assess thoracic rotation

Cervical spine

• Flexion - chin to chest
• extension - look up to the ceiling
• lateral flexion - ear onto each shoulder without lifting shoulder
• rotation - look over each shoulder

Question 8

Special tests

Answer 8

• TMJ function
• Straight leg raise
• perform a full neurological examination (Tone, Power, Reflexes, sensation) to determine level of spinal injurt or nerve root pathology
• assess the peripheral pulses

Question 9

TMJ function

Answer 9

• Ask patient to open and close mouth whilst feeling over the temporal mandibular joint

Question 10

Straight leg raise

Answer 10

Ask the patient to lie flat and elevate the lleg passively whilst keeping it straigh

This checks for nerve root irritation (radiculopathy) by stretching the sciatic nerve.

This leg should be raised until pain is experence in the thigh, buttock, calf and foot. Record angle at which pain is experienced. Pain that occurs before 30 degrees s not due to disc prolapse, as the nerve root is not stretched at this range. When pain is experienced, the foot should be dorsiflexed, this is known as the sciatic nerve stretch test adn is deemed positive if the pain increases on dorsiflexion. Flexing the knee will abolish the pain

Contralateral SLR- elevation of the contralateral leg will also produced pain on the side of the leg that is being raised in severe acute prolapsed disc.

Question 11

Pain on flexion suggests

Answer 11

Disc related disorder

Question 12

Pain on extension suggests

Answer 12

Sponylithesis or spinal stenosis