Spine Examination Checklist

Question 1

1) What are the initial steps in a spine examination?

Answer 1

introduce self
identify patient
Infection control
explanation - Look, feel move
consent
check for discomfort (“Do you have any pain?”)
adequately expose spine (all clothing above the waist)

Question 2

2) What should be inspected from behind during a spine examination?

(and how)

Answer 2

Position of head
position of neck
position of shoulders
thoraco-lumbar scoliosis (standing and bending forward)

Question 3

What is being assess when pt is bendinf forward

Answer 3

Asymmetry in rib height

Question 4

3) What should be inspected from the side during a spine examination?

Answer 4

Cervical lordosis
thoracic kyphosis (+/- gibbus)
lumbar lordosis.

Question 5

Head to one side

Answer 5

Muscle spasm

Question 6

what is thoracic kyphosis and what can cause it?

Answer 6

Excessive neck flexion
thoracic vertebrae wedge fractures/ ankylosing spondylosis

Question 7

4) What areas should be palpated during a spine examination and why?

Answer 7

Supraclavicular region - lymphadenopathy
Mid-line - cervical to lumbar spinous processes for coronal alignment
Paraspinal muscles - muscle wasting, spasm
Iliac crest heights - asymmetry pelvic tilt
Sacroiliac joints - tenderness
Chest expansion (ankylosing spondylitis suspected) - restriction

So Many People I Should Call

Question 8

What does a step between spinous processes mean?

Answer 8

Spondylolisthesis

Question 9

5) What active movements should be assessed in the cervical spine and where are they observed from?

Answer 9

Flexion - chin to chest (side)
extension - head to back (side)
lateral flexion - ear to shoulder (behind)
rotation - over each shoulder (above)

Question 10

What active movements should be assessed in the lumbar spine?

Answer 10

Flexion - bend forward (side)
extension - bend backwards (side)
lateral flexion - hand down leg (behind)

Question 11

What special tests are performed during a spine examination?

Answer 11

Schober’s test to assess lumbar flexion if ankylosing spondylitis suspected, straight leg raise.

Question 12

What should be done during the closure of a spine examination?

Answer 12

Explanation and appropriate documentation of findings, thank patient, infection control.

Question 13

What is a normal Schober’s test?

Answer 13

Normal flexion is represented as >20cm between point A and B. Less than this represents limited flexion.

Question 14

How is Schober’s test performed?

Answer 14

Identify POINT A 10cm above posterior superior iliac spines and POINT B 5cm below this level. Measure the distance between A and B before and after the patient leans forward.