What should be assessed for in a spine exam
pain
stiffness
perceived loss of ROM
distal neurological findings
What is important to ask with pain with spinal exam
localized or diffuse
worse with activities or position
how long has been around
What is important to ask with associated symptoms with spinal exam
numbness or weakness
change in bowel or bladder function
What ask with PMHx with spinal exam
fracture
sprain/strain
disc herniation
What ask with SHx with spinal exam
occupation
hobbies
smoking
How does smoking affect spine
nicotine impairs healing of spinal effusion
What ask with txt with spinal exam
Pain Relievers Ice/Heat NSAIDs CHiropractors pneumonic: PINCH
What ask with activities of daily with spinal exam
how pain affect it
How should a person be exposed for a spinal exam
expose entire back from shoulders to below pelvic bones
feet together and arms at sides
What should be inspected for spinal exam
- Skin
- head midline along with sacrum
- shoulders and pelvis should be level
- look at gait as walk (list or limp)
What is normal posture
- 2 concave curvatures
- 2 convex curvatures
Where are the concave curvatures of the spine
cervical
lumbar
Where are the convex curvatures of the spine
thoracic
sacrococcygeal
What will you see in scoliosis
asymmetry of spinal column
asymmetry of shoulder height
What causes winging of scapulae
thoracic scoliosis
long thoracic nerve palsy
What does “listing” of the trunk to one side suggest
herniated lumbar disc
What does tenderness at C1-C2 indicate
subluxation in rheumatoid patient
What do tenderness of facet joints indicate
arthritis at C5-C6 level
What do lumbar “step-offs” indicate
spondylolisthesis
fracture
What are the muscles that are examined in the spinal exam
cervical paraspinals and trapezius
thoracic paraspinals and rhomboids
lumbar paraspinals
Where is the sciatic nerve
midway between greater trochanter and ischial tuberosity
What does tenderness of the sciatic nerve indicate
disc herniation
mass lesion
L4-S3
What is the most mobile segment of the spine
cervical
What tested for cervical ROM in spinal exam
flexion (chin to chest)
extension (look at ceiling)
rotation (head to each side)
lateral bending (ear to shoulder)
What is the atlantooccipital joint
Atlas
controls 1/3 flexion
controls 1/2 lateral bending
What is atlantoaxial joint
axis
controls 1/2 rotation
What does the 3rd through 7th vertebrae control
2/3 flexion and extension
1/2 rotation
1/2 lateral bending
What ROM for thoracic and lumbar vertebrae in spinal exam
flexion (bend forward and touch toes)
extension (bend back)
rotation
lateral bending (lean to one side)
What is straight leg raise test for spinal exam
test sciatic pain
lie on table and you passively extend leg at hip
What are the levels of the straight leg raise test for spinal exam
0 to 30 degree pain - lumbar nerve root impingement
30 to 60 degree pain - sacroiliac OA disease
>60 degree pain - lumbosacral OA disease
What are the muscle strength tests for spinal exam
hip flexion knee extension ankle dorsiflexion great toe extension plantar flexion power
What are the sensory tests for spinal exam
eyes closed anterior thigh - L1-L3 inside lower leg - L4 top foot and toes - L5 outside ankle and foot - S1
What are the reflex tests for spinal exam
Cervical -biceps (C5) -brachioradialis (C6) -triceps (C7) Lumbar - patellar - L4 - achilles - S1