Spine examination – peer assessment

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Introduction
Wash hands or use Hand gel
Introduce yourselves to the patient
Obtain patient’s name and date of birth
Outline what the examination will consist of and gain consent Warn the
patients of possible discomfort
Check the patient is comfortable on couch with adequate exposure of the
knees – shorts

Look
With the patient standing, from behind assess for:
- Asymmetry
- Muscle wasting
- Scoliosis
With the patient standing, from the side assess for:
- Cervical and lumbar lordosis
- Thoracic kyphosis
Feel
Palpate the following areas for tenderness:
- Spinous processes
- Sacroiliac joints
- Paraspinal muscles
Move
Lumbar flexion and extension
- Palpate adjacent lumbar spinous processes-2 hands
- Ask the patient to bend and touch their toes
- Your fingers should move apart to show lumbar flexion is
contributing to the movement, i.e. not all hip flexion
Lateral flexion thoracolumbar spine
- Ask the patient to run each hand down the adjacent leg in turn
Lateral flexion cervical spine
- Tilt head to bring ear to shoulder (correct them if they lift shoulder
to ear)
Rotation of cervical spine
- Look over each shoulder in turn
Flexion and extension of cervical spine
- Chin to chest
- Look at the ceiling
Rotation of thoracic spine
- Ask the patient to sit on side of couch (fix pelvis)
- Cross their arm in front of them
- Place your hands on their shoulders and guide rotational
movement
Special tests
Straight leg raise
- Lie the patient flat, supine on the couch
- Raise each straight leg of the bed in turn
- Dorsiflex the ipsilateral foot, does this exacerbate the pain
Assess limb reflexes
- Upper and lower limb
Assess distal lower limb power
- Power of dorsiflexion of great toe
Assess distal pulses
Conclusion
If any neurological symptoms or signs are present you would perform a full
neurological history and examination and consider a DRE.

THIS IS NOT AN OSCE MARK SHEET

Emma McAllister. Newcastle University.