EXAMINATION OF THE SPINE

Component Examined
Task
Greets & introduces self to the patient.
Determines how the patient wishes to be addressed.
Introduction Explains nature of the examination to the patient.
Obtains consent, Ensures privacy and confidentiality.
Washes hands before and after examination.
1. Ask about the affected area (Ask the patient: where is the pain?)
Note: always you will start the examination with the normal side.
LOOK
2. Positions: Standing
FELA 3. Exposure: Chest exposed.

4. General Inspection: Observes general appearance of the patient:

comment if the patient ill “in pain “or well, if there is any deformity.

You will observe the spine from side & behind.

(You will look to Cervical, Thoraco-Lumbar and Sacral vertebrae).
WALK
1. Inspect the gait by asking the patient to walk. (Comment if it is a normal
gait or not).
2. Inspect the posture & alignment. Inmate outward
(Normal alignment - Cervical lordosis, slight upper dorsal kyphosis &
thoraco-lumber lordosis).
3. Inspects Symmetry of shoulder height, scapulae, posterior ribs & iliac
crests.
Sss 4. Inspects the Shape for any swellings i.e. tumors & effusion.
5. Inspects Skin all around the joint for discoloration (Erythema, Bluish) and
scars.
6. Inspects Muscles all around the joint “Superficial and deep muscles” for
atrophy (muscles wasting).
7. Inspects Bones for any deformity (scoliosis, kyphosis, and lordosis) that
cause loss of normal curvature.
curves

Note:
Always you will start the examination with the normal side.
1111111
During palpation look to the patient’s face.
I
FEEL

1. Palpates the Skin for the temperature with the dorsum of your hand over the
Year Cervical, Thoraco-Lumbar and Sacral vertebrae by using dorsum of one
hand ONLY.
stem 2. Palpates the Muscles (trapezius and paravertebral Muscles) for tenderness
and atrophy (muscles wasting).
unsafe 3. Palpates the Bones surface landmarks start from base of skull down to
spinous prominence of L4 for tenderness, swellings and deformities.
4. Palpates the Joint (Sacroiliac joints).
5. Palpate the supraclavicular fossa for cervical rib.
Eis
. References:
-Clinical Examination 8th edition Talley O’Connor Edited By Dr.Mada Daghistani 2023
 EXAMINATION OF THE SPINE
Start with the Zero position: Arms hanging by the side with the palms facing
MOVE upwards.

1) ACTIVE range of motion “ROM“(Done by the patient).

0
“ ONLY
ACTIVE “
A) Cervical:
● Flexion = 45 o (chin down to chest)
● Extension = 50 o (look up at ceiling)
● Lateral Flexion = 45 o (side bending - ear to shoulder)
● Rotation = 70 o Rt / Lt (turn head to each side)

B) Thoracic-Lumbar / Sacral
● Flexion: Thoracic=45 o, Lumbar= 60 o (touch toes)

✔ Using your hands to fix the patient pelvis then ask him to do:
● Extension = 30 o (ask the patient to arch his back)
● Lateral Flexion = 30-35 o Rt / Lt, (ask the patient to slide hand
down the side of each leg).

✔ Ask the patient to sit with arms crossed then ask him to twist

● co
while the pelvis is fixed
Rotation Rt / Lt 40 o (Thoracic 35 o + Lumbar 5 o)

Special Tests
1. Schober's test “ Pt standing “
2. Straight leg raising “ Pt lying in supine position “
3. Femoral nerve Stretch test “Pt lying in prone position “

Mention the need to examine a) Upper and lower limb neurological

CLOSURE examinations b) Abdominal examination to rule out referred pain.
- Drapes the patient appropriately.
- Makes appropriate closing remarks.

. References:
-Clinical Examination 8th edition Talley O’Connor Edited By Dr.Mada Daghistani 2023
 EXAMINATION OF THE SPINE
# Cervical Spine movement:

# Thoracic -Lumbar spine movement:

. References:
-Clinical Examination 8th edition Talley O’Connor Edited By Dr.Mada Daghistani 2023
 EXAMINATION OF THE SPINE
# Special Test

1- Schober's test “ Pt Standing “

While the patient is in a standing position, the examiner

mark the level of L5, then measure 5 cm below and 10 cm
above the L5 point.
After that ask the patient to touch his/her toes while
keeping the knees straight.

Negative Test “Normal “: If the distance of the two points

increase by more than 5 cm.

Positive Test “Abnormal “: If the distance of the two

points do not increase by at least 5 cm. This is a sign of
limitation of lumbar flexion. (Ankylosing spondylitis).

2- Straight leg raising “ Supine position “

With the patient lying in supine position, lift one

leg then dorsiflexion of the foot. Ask the pt to tell
you as soon as there is pain.

Negative Test “Normal “: No pain

Positive Test “Abnormal “: Ipsilateral pain

(Sciatica nerve compression).

3- Femoral stretch test “ Prone Position “

With the patient lying in prone position, places one

hand on the patient's pelvis to prevent movement,
while the other hand flexes the knee and raise it up.
Negative Test “Normal “: No pain

Positive Test “Abnormal “: Ipsilateral pain

Femoral nerve compression (Lower back area,
anterior thigh).

. References:
-Clinical Examination 8th edition Talley O’Connor Edited By Dr.Mada Daghistani 2023