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Spine Examination Checklist
- 1. SPINE EXAMINATION CHECKLIST (PART Ist) -PRESENTOR- DR. ARCHIT JAIN UCMS & GTB HOSPITAL DELHI
- 3. SPINE EXAMINATION PRE-REQUISITES & POSITION Appropriate exposure Standing / Sitting / Lying If quadriplegic/paraplegic: -Supine -Guarded rolling lateral position
- 4. INSPECTION
- 5. INSPECTION GAIT ATTITUDE INSPECTION FROM BACK INSPECTION FROM SIDE INSPECTION FROM FRONT
- 6. GAIT -only if no contra-indications to ambulation- GAIT CHARACTERISTICS EXAMPLE Painful spine Cautious gait avoiding painful jerks Different parts of spine held stiff Potts Spine Ankylosed spine Spine, SI, Hip moves as a one segment Ankylosing Spondylitis (advanced stage)
- 7. ATTITUDE
- 8. ATTITUDE Attitude of flexion at whole of the spine ANKYLOSING SPONDYLITIS
- 9. ATTITUDE Hip, Knees flexed Hands faced backwards Obliteration of lumbar lordosis SIMIAN STANCE LUMBAR CANAL STENOSIS
- 10. ATTITUDE Avoid slightest of movement at cervical spine Holding the head with one/both Hands at cheek/chin Children Cervical/ Upper dorsal painful inflammatory lesion
- 11. ATTITUDE Helps in bypassing the weight-bearing Stand by placing the hands on the knees Dorso-Lumbar spine painful inflammatory lesion
- 12. ATTITUDE Tries to take the nerve root away from the offending disc Prolapsed Intervertebral Disc Trunk deviated to one side
- 13. LIST IN PIVD Involved nerve root Offending disc Disc prolapse LATERAL to nerve root Disc prolapse MEDIAL to nerve root Trunk deviates AWAY from side of prolapse Trunk deviatesTOWARDS side of prolapse “SHOULDERTYPE” “AXILLARYTYPE”
- 15. INSPECTION (BACK) 1. Position of head 2. Hairline 3. Short neck 4. Level of scapula 5. Curvature of spine 6. Lateral margins of trunk 7. Central furrow (Prominent/Obliterated) 8. Skin: Scars/Sinuses/Swelling/Spots Vessels/Vesicles/Visible Pulsations
- 16. INSPECTION (BACK) 1. Position of head Uncompensated scoliotic deformity- deviated 2. Hairline KFS 3. Short neck KFS Cervical Potts 4. Level of scapula Scoliosis Sprengel’s shoulder 5. Curvature of spine List Scoliosis 6. Lateral margins of trunk Scoliosis 7. Central furrow (Prominent/Obliterated) Prominent-Paraspinal muscle spasm Obliterated-kyphotic deformity/muscle wasting 8. Skin: Scars/Sinuses/Swelling/Spots Vessels/Vesicles/Visible Pulsations Tuft of hair in L-S area: underlying spinal cord pathology (Spina bifida)
- 18. INSPECTION (SIDE) Spinal Deformities (Saggital plane): Lordosis Kyphosis
- 19. INSPECTION (SIDE) Lordosis Normal Cervical (20-40), Lumbar (40-60) Exagerrated Spondylolisthesis Compensation to FFD @ Hip Obesity Pregnancy Obliteration Ankylosing Spondylitis Paraspinal muscle Spasm KNUCKLE ANGULAR ROUNDED Kyphosis Normal Thoracic spine (20-45) Knuckle (1 v.) Angular (2 or 3 v.) Potts Spine Rounded (>3 v.) Senile osteoporosis Scheuermann disease
- 21. INSPECTION (FRONT) Prominence of chest Sternum Level of ASIS DEFORMITY Prominence of Chest Rotation of thoracic vertebra (horizontal plane) asymmetric prominence of rib cage RIB HUMP SCOLIOSIS
- 22. PALPATION
- 23. PALPATION TEMPERATURE TENDERNESS PARASPINAL MUSCLE SPASM DEFORMITY DISTANT SWELLINGS
- 24. How to palpate spine? Palpation of spinous process- all along the spine- with finger tips A quick screening method Reference point to count vertebra: - First spinous process palpable: C7 (vertebral prominens) HOLDSWATH METHOD
- 25. TEMPERATURE
- 26. TENDERNESS 1. Direct tenderness 2. Rotatory (or twisting) 3. Thrust
- 27. DIRECT Pressure on spinous process directly Posterior element disease Advanced Anterior element disease ROTATORY Attempted rotation of the spinous process (pressing at base of suspected spinous process) Anterior element disease Posterior element disease THRUST Lightly thrusting the spine with fist Anterior element disease
- 28. PARASPINAL MUSCLE SPASM What does it indicate? Painful lesion of the spine at that level Three Methods
- 29. METHOD PROCEDURE 1. Paraspinal muscles - Tapping Tapping over the paraspinal muscles directly 2. Spinous process- Press Muscle spasm manifest as visible & painful contraction of PSM adjacent to diseased vertebra 3. Kibler test Attempted movement of piched KIBLERTEST PARASPINAL MUSCLE SPASM (METHODS)
- 30. DEFORMITY Mark the sufficient no.of normal vertebrae adjacent to diseased vertebra Mark the spinal landmarks Palpate the step : Spondylolisthesis/ Acute fracture-dislocation
- 31. VERTEBRAL LEVELS C7 –Vertebra prominens (first prominent spinous process of cervical spine) D3 – Spine of Scapula D7 – Inferior angle of Scapula L4 – Highest point of iliac crest S2 – PSIS
- 32. DISTANT SWELLINGS SITE ABSCESS DISEASE Neck Retropharyngeal abscess Cervical Pott’s Anterior chest wall Cold abscesses Thoracic Pott’s Axilla Cold abscesses Thoracic Pott’s Iliac fossa Psoas abscess Thoraco-lumbar Potts
- 33. MOVEMENTS
- 34. MOVEMENTS Flexion / Extension Lateral Flexion Rotation
- 35. MOVEMENTS- MOTION SEGMENT Movement of spine occurs at : -IVD -facet joints Constitutes a “ Motion segment”
- 36. MOVEMENTS OF CERVICAL SPINE 800 500 800 800 450 450
- 37. MOVEMENTS OF DORSOLUMBAR SPINE
- 38. MEASUREMENTS
- 39. MEASUREMENTS Chest expansion Finger-Floor Distance Modified Schober’s test
- 40. CHEST-EXPANSION TEST Chest Expansion is contributed by: COSTOTRANSVERSE JOINTS COSTOVERTEBRAL JOINTS STERNOCOSTAL JOINTS Procedure: 1. Full exhalation Inhales maximally 2. Measuring tape @ level of 4th ICS Results: Normal= 6cm <2.5 CM = Highly s/o ANK. SPONDYLITIS COSTOTRANSVERSE JOINT COSTOVERTEBRAL JOINT
- 41. FINGER-FLOOR DISTANCE Ask the patient – maximally flex the DL Spine Measure the distance between fingertips and floor Normal: within 7 cm of the floor
- 43. SPECIAL TESTS
- 44. SPECIAL TESTS Cervical cord compression Axial compressionTest Spurling’sTest Lhermitt’sTest PIVD Lasegue’s test (SLRT) BragardsTest Bowstring Test Crossed SLRT SlumpTest Femoral nerve stretch test SI-Joint test Patrick’s four part sign Genslen’sTest Gillie’sTest Pelvic DistractionTest
- 45. CERVICAL CORD COMPRESSIONTEST AXIAL COMPRESSIONTEST SPURLING ‘STEST
- 46. LHERMITT’STEST “Barber Chair phenomenon” Maximally flex C-spine and T-Spine Electric shock like sensation in all the limbs s/o spinal stenosis , spinal cord compression
- 48. BOWSTRINGTEST CROSS SLR TEST (aka WELL LEG SLRT , FRAJERSZTAJNTEST)
- 49. SLUMPTEST
- 51. THANKYOU!
Editor's Notes
- Moving ahead in the series of discussing checklist of examinations, today we will go through and discuss checklist of spine examination.
- Observing the gait and attitude of the patient – is the first step in inspecting the patient with suspected spine disease
- Gait may provide imp clue but one should remember to examine the gait only if there is no…. Patient with painful inflammatory lesions ..walks with cautious..
- Certain patients may stand with an attitude…
- In some other patients they tens to stand with their hip, knees….. Lumbar lordosis is lost to achieve uniform dorso-lumbar flexion…
- List: deviation of spine to one side--PIVD
- KLI-PPEL FEIL SYNDROME Dilated vessels
- Lordosis: spinal curvature- convex anteriorly
- These should not be performed when nerve root compression with a motor deficit is suspected or detected. To perform the axial compression test, the examiner stands behind the patient who is seated with the cervical spine in a neutral position. The examiner then places both hands at the crown of the patient's head and compresses, thus supplying an axial load. The application of the force should be gentle and gradual because it may elicit a very painful response. The patient is asked to report whether the maneuver produces pain or other unpleasant sensations, as well as the quality and distribution of the symptoms created. SPURLING TEST Spurling’s maneuver: extension and rotation of cervical spine produce radicular pain, it is pseudoradicular if the pain radiates to occiput or scapula or limbs but not below elbow
- Bowstring sign of McNab: perform SLRT stop at the hip flexion where pain is produced flex knee to 90° press the sciatic nerve in popliteal fossa strengthens the impression of sciatica. Crossed SLRT (well leg SLRT, Frajersztajn test): extremely sensitive for L4-5 and L5-S1 disc.
- Genslens Test Involved hip is extended by allowing it to overhang from the edge of the couch Normal hip and knee flexed Gillie’stest Prone---Press down on the uninvolved side --------involved side –with knee 90o --- extended by lifting off