Examination: Spine
There are 6 main concepts that need to be remembered for ALL of the regional examination of the musculoskeletal system:
- Position – always position your patient as you would like to examine them before you begin
- Look – inspect and observe the patient and around the patient's bedside
- Feel – for example, feeling a joint to see if it is hot or swollen
- Move – actively (the patient moves the joint) then passively (you do the movements for them)
- Function – can the patient move their joints in order to complete day to day tasks?
- Special tests – if applicable
- Wash hands
- Introduce yourself
- Ask permission to examine the relevant part of the body
- Expose the patient – ideally in underwear only, at least exposing the joint of interest and the joints above and below this
- Reposition the patient – standing up at first
Position:
- Patient standing up
Look:
- Front, sides and back
- For normal cervical lordosis, thoracic kyphosis and lumbar lordosis
- For scholiosis
- Question mark sign in Ankylosing Spondilitis
Feel:
- The spine of each vertebra
- The paravertebral muscles
- The sacroiliac joints
Move:
- Actively:
- Ask patient to touch their toes as you put two fingers on 2 vertebrae. They should significantly move apart as the patient bends forward.
- Assess lateral flexion
- Assess cervical movements:
- Touch ear to shoulder (lateral flexion)
- Look up (extension)
- Look down (flexion)
- Look left (rotation)
- Look right (rotation)
- Passively:
- Ask patient to sit down and cross arms
- Rotate the patient's torso to look left and right - assesses thoracic rotation
Function:
- Already assessed
Special testing:
- Stretch test:
- Ask patient to lie town. Lift up a straight leg and dorsiflex the foot. This may exacerbate pain from a nerve root entrapment or irritation
To conclude the examination:
- Thank the patient
- Tell them they can get dressed now
- Offer to examine the joint above and the joint below
- Consider neurological examination of the limb examined
The complete examination of the musculoskeletal system includes:
- Examination of the hand and wrist
- Examination of the elbow
- Examination of the shoulder
- Examination of the spine
- Examination of the hip
- Examination of the knee
- Examination of the ankle and foot
Extras:
download in pdf
written by: celine_lakra,
first posted on: 09/01/12, 22:17
first posted on: 09/01/12, 22:17
comments:
POSTED ON: 12/01/14, 15:29
POSTED ON: 09/05/14, 14:12
To clarify:
Cervical spine normally has an element of lordosis
Thoracic spine normally has an element of kyphosis
Lumbar spine normally has an element of lordosis
All of these can been exagerated or removed by pathological processes (such as crush fractures, degeneration, etc.)
BW,
Joel
POSTED ON: 08/03/16, 12:40
POSTED ON: 07/06/22, 07:49
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Schober's Index: measures lumbar spine mobility
Mark central point between posterior superior iliac spines (dimples in lower back)
Measure 10cm above and 5cm below PSIS (15cm in total)
Ask pt to bend forward as far as possible with their feet hip-width apart and not bend their knees
Measure the distance again
The distance should increase by >5cm (to >20cm)
<5cm is of concern (Ankylosing Spondylitis)