Spine Exam

Question 1

Spine exam - Look

Answer 1

• From behind:
  
  • Posture of the head, neck and shoulders
  • Thoraco-lumbar scoliosis (standing, bending forwards)
• From the side: cervical lordosis, thoracic kyphosis (+/- gibbus), lumbar lordosis

Question 2

Spine exam - Feel

Answer 2

• Supraclavicular: feel for cervical ribs or enlarged lymph nodes
• Mid-line: spinous processes (cervical to lumbar vertebrae)
• Para-spinal muscles (muscle bulk and note any spasm)
• Iliac crest heights (asymmetry or excessive pelvic tilt)
• Sacroiliac joints
• Chest expansion (only if ankylosing spondylitis suspected)

Question 3

Spine exam - Move

Answer 3

• Cervical spine: flexion/extension, rotation (left/right ideally with patient sitting and observe from above), lateral flexion (left/right)
• Lumbar spine: flexion, extension, lateral flexion (left/right)

Question 4

Spine exam - Special tests

Answer 4

1. With the patient standing and facing away from you, find the level of the sacroiliac joints,
   identify (with a finger or mark) POINT A 10cm above this level and POINT B 5cm below this
   level in the midline
2. Hold the tape measure at point A and let it dangle down to point B
   (where it should read 15cm)
3. Now ask the patient to flex/lean forward as if trying to touch their toes and observe the new length between point A and B

Results

• Normal flexion is represented as >20cm between point A and B
• Less than this represents limited flexion, such as may be found in ankylosing spondylitis