The orthopaedic examination involves looking at the patient's spine for any deformities, imbalance, swelling or wasting, feeling the spine for tenderness at spinous processes and paraspinal muscles as well as temperature and step off, moving the spine through its ranges of motion including special tests like the straight leg raise test to detect problems like herniated discs, and performing a full neurological exam. The exam must be tailored based on clinical suspicions and involve assessing both positive and negative findings to prove or rule out diagnoses.

1. THE ORTHOPAEDIC EXAMINATION

2. BASIC RULES
LOOK
FEEL
MOVE
SPECIAL TESTS

3. SPINE EXAMINATION

4. KNOWLEDGE….
 “The eye does not see what the mind does
not know”
 Know common spine problems…
 Eg: trauma, infection, tumor, degen,
deformity…
 Young – PID (HNP), infection…
 Old – DDD (degen), spondylolisthesis,
secondaries…
 TAILOR YOUR EXAMINATION TO WHAT IS
SUSPECTED – P.E IS NOT A SET
ROUTINE

5. LOOK

6.  Adequate exposure! (No shyness in exams!)
 Always look from back, side, front

7. Always search for:
• Deformities
• Imbalance
• Swellings
• Wasting
• Scars
• Sinus

8. Adam’s bending test

9. Gibbus – a/w TB spine – common occurrence

10. Wasting Scars

11. FEEL

12.  Must see pt’s face – tenderness – how?
 Identify important anatomical landmarks

13. WHAT ARE YOU LOOKING FOR?
 Tenderness
 Spinous process
 Paraspinal
muscles
 Temperature
 Step off

14. MOVE

15. POINTS TO REMEMBER
 Spine has 6 axis of movement
 Movement mainly at cervical and thoracolumbar
spine
 Must know how to instruct patients on
movement!

16. CERVICAL MOVEMENT

17. THORACOLUMBAR MOVEMENT
Additional test to do during flexion – Schober’s test

18. SCHOBER’S TEST
Determine
flexion occurs
at spine and
NOT hip

19. SPECIAL TESTS

20. STRAIGHT LEG RAISING TEST (SLR)
 To detect PID (HNP)

21. OTHER TESTS
 Cross straight leg raising
 Bowstring test

22. FULL NEUROLOGICAL EXAMINATION

23. POINTS TO PONDER
 P.E must be done with knowledge
 It is NOT a set routine, must be targeted
 Must be able to spot diagnosis even before
starting P.E
 Your P.E is to prove the diagnosis by
searching for relevant positives
 And to rule out other diagnosis by searching
for relevant negatives

24. THANK YOU