Spine Examination
Extracted text:
Spine Examination
Standing (Exposure):
-
Anterior:
- Head or neck tilt (+ torticollis)
- Shoulder symmetrical
- Skin (cafe au lait) (NF)
-
Side:
- Cervical lordosis, thoracic kyphosis, lumbar lordosis
- Gibbous (+TB)
-
Posterior:
- Head or neck tilt, pelvic tilt
- Shoulder symmetrical
- Hair tuft (spina bifida)
- Dimpling (sinus/scar)
- Scar
- Wasting of paravertebral muscles
- Scoliosis
Gait:
- Antalgic gait (radiculopathy)
- Shuffling gait (Parkinsonās disease)
- Waddling gait
- High stepping gait
- Short limb gait
Differential Diagnosis (Ddx):
- Spine metastasis
- TB spine
- Pyogenic discitis
- Spondylolisthesis
- Spondylolysis
Feel:
- Ask pain?
- Palpate spinous process for tenderness, alignment (scoliosis), step deformity
- Paravertebral muscles for tenderness (collection/abscess TB), spasm
Move:
| Cervical | Lumbar | Thoracic |
|---|---|---|
| Flexion: chin to chest | Flexion: Schoberās test | Ask patient to sit |
| Extension: look at ceiling | Lumbar excursion: | Rotation: rotate left & right |
| Lateral flexion: ear to shoulder, right & left | - Ask patient to flex, touch toes | |
| Rotation: look right & left | - 7.5 cm excursion is normal | |
| Stabilize the spine during movements | - <5 cm indicates ankylosing spondylitis | |
| - Extension: lean backward | ||
| - Lateral flexion: right and left | ||
| - Hold the spine |
Special Tests:
-
Straight Leg Raise (SLR):
- To look for sciatica
- Lift leg 30Ā°: provoke pain
-
Sciatic Stretch Test:
- Lift down until no pain
- Ankle dorsiflexion elicits pain
-
Crossed SLR:
- Pain felt bilaterally
- Indicates central HNP
-
Lhermitte's Sign:
- Neck flexion ā electrical sensation to all 4 limbs
-
Hoffmanās Sign
Stages of HNP:
- Degeneration
- Prolapse
- Extrusion
- Sequestration
Complete Examination:
- BCR (Bulbocavernosus reflex)
- Perianal sensation
- Deep anal sensation
- Voluntary anal contraction
- PR exam (S2 - S4)