Back examination

Back examination
• Before starting ….
• Introduce yourself
• Ask permission to perform examination
• Explain the patient appropriately
• The patient must be exposed properly
• Tell the patient to let you know if anything you do is uncomfortable or
painful
• When female patient –make sure that female nurse or assistant is
present.
Clinical examination of the spine
• History
• General examination
• Inspection =look
• Palpation = feel
• Movment and measurments
• Special tests
• Neurology
 Inspect
• Gait (walking without shoes), check
tip toe walking ,and heel.
• Posture ( look from the patient :
o Back for scoliosos (thoraco-lumbar)
o sides for kyphosos (thoracic) and
lordosis( cervical and lumber )
o Skin (erythema , swelling , scars , hair
patch, fat pads )
o Muscle wasting (leg or gluteal ).
Palpate :
• Temperature Bilaterally
• Tenderness (using your thumb ): over spinous process, paraspinal muscles , paravertebreal area ,
sacroiliac joint , anterior and posterior iliac spines
• Masses or muscle spasm
• Percuss :
• Light on the back for any tenderness using fist.

Positive if ?
 • Check range of motion :
Flexion
• Bending forward ( if limited indicates disc pathology)
• Extension:
• Bending backward ( if limited indicates
spinal stenosis , spondylolisthiasis or
usually facet pain)
• Lateral rotation :
Bending to both sides (if limited indicates muscular pathology)
 Schober test
an increase of less than 5cm is a positive test and may
indicate ankylosing spondylitis (AS).
Special test
• Stright leg raising test (SLR):
Positive if shooting sciatica pain between 30 to 70 degrees:pain radiate
below the knee that some times associated with numbness and
paresthesia indicating herniated disc.
• Bragards test:
• used to confirm a positive straight leg raising test .
• Bowstring sing or tibial stretch sign:
passively bend the patient knee and press at the popliteal fossa
( positive if sciatica pain is elicited and indicates herniated disc)
• Femoral Stretch sing :
• extend the hip while patient lying pron or in the side) positive if
ipsilateral pain elicited and indicates involvement of L3-L4 root )
• Neurological examination :

• Sesnsation of the foot : Medical side L4 , Dorsum (L5) and

lateral side (S1)
• Power: dorsiflextion (L4-L5) AND plantar flexion (S1)the foot.
• Reflexes :Knee jerk (L3-L4) ANKLE JERK (S1-S2), and ankle
clonus
• End your exam with :
• Quick palpation and range of motion checking of neck and hip
• Abdominal palpitation to exclude abdominal aortic aneurysm
• Digital rectal exam to check for anal spincter tone .
• Give feedback and thank the patient