This document provides an overview of the clinical examination of the spine. It describes examining the patient's history, general examination including inspection of posture and deformities, and localized palpation of the cervical, thoracic, lumbar, and sacral spine. Specific tests are outlined to assess the range of motion and integrity of the spine as well as nerve root tension including the straight leg raise test. A neurological examination of motor function, sensation, and reflexes is also recommended to evaluate for any neurological deficits.

1. CLINICAL EXAMINATION OF
SPINE
Lt Cdr Anup Maurya
Resident Orthopedics

2. • Introduction

3. COMMON CONDITIONS AFFECTING
SPINE

4. Clinical Examination

6. History

7. General Examination

8. General Examination

9. General Examination

10. General Examination

11. General Examination

12. Local Examination
• Start with standing and then lying down position

13. • Skin
• Scars
• Sinuses
• Pigmentation
• Unusual skin creases
Kippel Feil Syndrome
• Low hairline
• Fusion or absence of
cervical vertebra
• May be assciated
with Sprengel
Shoulder

14. • Attitude and Deformity
• Position of head, shoulder and scapula
• Rib Hump/ crowding

18. Anteriorly
Levels of Nipples
Shape of Chest
Rib Hump
Abdominal Protrusion

19. Palpation

24. Cervical Spine
• Inspection
• General examination
• Look for posture symmetry, scapular prominence, skin, muscle wasting
• Observe for muscle spasm or contracture
• Enlarged lymph nodes/ thyroid gland

25. • Palpation
• Palpate for tenderness and masses
• Posteriorly in midline, laterally and
supraclavicular area
• Paras spinal tenderness radiating to trapezius
even crepitus is found in cervical spondylosis
• One hand may be cold/ atrophic and
discoloured in case of cervical rib
• Front of the neck for thyroid and lymph nodes

26. • Huckster Tender Triad
• Tenderness at the base of neck
• Over insertion of deltoid
• In the extensor mass of forearm
• Rotation
• Should be equal
• About 70-90% on each side
• Flexion and extension
• Flexion- chin touching the chest
• Extension - 50 deg beyond horizontal

27. • Lateral Flexion
• 40 deg on each side

28. Thoracic Spine
• Inspection
• As discussed earlier
• Deformities
• Scoliosis
• Kyphosis
• Lordosis
• Tenderness is elicited by light percussion over the spinous processes with patient leaning forward
• Rotational stress form side to side to elicit crepitus
• In cases of lumbosacral spondylolisthesis tenderness may be accompanied by palpable step

29. • Active Range of Motion

30. • Schober’s Test
• Assesses the amount of lumbar flexion
• Done to objectively measure the degree of
spinal flexion

32. • Measurements
• From occipital protuberance to tip of coccyx
• Iliocostal distance (tip of last rib cage to iliac crest)
• Chest expansion
• Limb lengths

33. • Lumbar Root Tension Test
• SLRT
• Modified Laseague test
• Reverse SLRT - FNST
• Braggart Sign
• Bowstring Test
• well leg SLRT

34. • SLRT (Passive)
• Test for lumbosacral nerve root irritation

35. • Bowstring Sign
• Performed after SLR, by lowering the leg a few degrees
• Apply compression on the lateral popliteal nerve behind the tibial
condyle to tighten it like a bowstring
• pressure in the popliteal fossa should provoke symptoms with a lesser
degree of SLR (excluding hamstrings Irritation as a cause)

37. • Crossed SLR/ Well leg raising test
• Serve root irritation is indicated when SLR of the leg on the unaffected
side produces pain on the affected side
• SLR is 91% sensitive but 32% specific (better negative predictive value)
• Crossed SLR is 98% specific but 32% sensitive (positive predictive
value)

40. Braggards Sign

42. Reverse SLRT

43. Lhermitte’s Test

44. Nafziger Test

45. Test for SI Joint
• FABER Test
• Compression Test
• Distraction Test
• Gaenslen’s Test
• Pump Handle Test
• Gille’s Test

47. Neurological Examination
• Higher Mental Function
• Cranial Nerves
• Motor
• Sensory

48. Motor Neurology
• Bulk
• Tone
• Nutrition
• Power
• Coordination
• Reflexes
• Involuntary movements

49. Sensory Examination
• Pain
• Temperature
• Light touch
• Pressure
• 2 point discrimination
• Joint position and Vibration

52. Determining the Neural and Vertebral Levels