Spine Examination

As with all orthopaedic examinations, the general principal is Look, Feel, Move. This is the same when examining the spine.

Subject steps

1. Start by asking the patient to remove their top. If you or the patient are uncomfortable with this in any way, ask a chaperone to join you first.

2. Examine the patient from behind, looking for any obvious abnormalities such as scars. Also note the muscle bulk and any wasting. Note the symmetry of each side and look for any scoliosis. Now look from the side to check for the normal curvatures of the spine. This is cervical lordosis, thoracic kyphosis and lumbar lordosis.

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3. Now feel the areas around the spine. Feel along the entire length of the spine, palpating each spinous process and checking with the patient for any tenderness. Now palpate the sacroiliac joints and finally the paraspinal muscles. As it is difficult to observe the patient's face for signs of discomfort, you should regularly ask them if what you are doing is painful.

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4. Movements of the spine are all performed actively. The first movements which are examined are lumbar flexion, extension and lateral flexion. Flexion and extension are checked by asking the patient to try and touch their toes (flexion) and then lean backwards (extension). These movements may be assessed quantitatively by placing the index and middle fingers 5 centimeters apart and noting how close and far apart they move on the movements. Lateral flexion is examined by asking the patient to run their hand down the outside of their leg.

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5. Cervical spine movements which are assessed are lateral flexion, rotation, flexion and extension. There are some easy commands for checking these. Lateral flexion: place your ear on your shoulder; rotation: look over your shoulder; flexion: put your chin on your chest; and extension: put your head back to look at the ceiling.

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6. The last movement to assess is thoracic rotation. For this the patient should be sat on the edge of the bed to fix the pelvis then ask the patient to turn to each side.

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7. The final check you to perform is laying the patient straight and asking them to perform a straight leg raise. This will exacerbate any pain due to nerve entrapment or disc prolapse.

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8. On completion, thank the patient for their time and wash your hands.