Spine Examination Himanshu Sharma Himanshu Sharma

Axial pain Radiculopathy Myelopathy Deformity

History  Site  Start + duration + course  Exacerbating / Relieving (stenotic)  Associated symptoms  Weakness  Coughing / P&Ns  % back : leg (arm)  Disability  Bladder/bowel dysfunction  Myelopathic symptoms  Management so far  Analgesia  Physio  Previous surgery

RED FLAGS OF SERIOUS SPINAL PATHOLOGY  Presentation 55 (65)  Non-mechanical pain, thoracic pain ?  Widespread neurology  Unwell, weight loss  Past history carcinoma, steroids, HIV  Structural deformity

Waddell’s 5 classes  Tenderness  superficial  non-anatomical  Simulation  axial loading  pseudo-rotation  Distraction  >40 o SLR difference sitting v supine At least 3 needed to be +ve  Regional disturbance  motor eg cogwheel  sensory - non anatomical  Overreaction  disproportionate pain response

Examination  Standing  Walking  Couch

Standing  Look  Back  Deformity  Swellings  Birth marks  Scars  Legs  Lower limb wasting  Cavus feet / claw toes  Feel  Site of tenderness  Move  Pain worse on flexion / extension ?  Heel and tiptoe stance

Ankylosing spondylitis  Chest expansion  Modified Schober test  Hip fixed flexion

Neurofibromatosis  Café-au-lait  Axillary freckling  Neurofibromas  Spinal deformity

Walking

Couch  Abdominal (AAA)  Hips +/- knees  Pulses  SLR + tension signs  (Femoral stretch)  Sensation  Motor  Long tract signs

Straight leg raise  Record angle on both sides  Record site of pain  Lasegues  reduce angle slightly + dorsiflex ankle  Bowstring test

Maps  Dermatome  Myotome  Sclerotome

Upper limbs Sclerotome map

Lower limbs Sclerotome map

Myotomes

Long tract signs  Romberg’s  Hoffman’s sign  Lhermitte’s sign  Increased muscle tone  Brisk reflexes  Clonus  Extensor plantars  Cavus feet (long standing)

Deformity

History  When first noticed  Any progression  Menarche / growth potential  Any pain & its nature  Neurological symptoms  Birth marks / PMH  Family history  Siblings

Examination  Trunk  shoulder height symmetry  rib hump - forward bending  waist asymmetry  hip asymmetry  side of curve and flexibility on suspension  leg length inequality  Neurological  upper and lower limbs  Subtle signs - abdo reflexes, Hoffman’s, clonus  Ligamentous laxity