The Spine:

For any spinal complaint:

• inspect for any obvious deformity (e.g. kyphosis & scoliosis), trauma, scars, muscle wasting, etc.
• palpate all spinal processes + joining muscles
• test range of movement (see below)
• perform (or say you would perform) a full neuro limb exam

N.B. if a cervical spine traumatic injury is suspected the patient should have their head & neck immobilised until assessment can take place (usually done in A&E), immobilisation = neck collar with head blocks either side & usually strapped to a spinal board

Cervical Spine

movement = 3 planes:

1. chin on chest then upwards (flexion & extension)
2. ear on each shoulder (lateral flexion)
3. chin on each shoulder (rotation)

Thoracic Spine

Movement = 1 plane:

• rotate spine (twist each way)

Lumbar Spine (think degenerative disease, ankylosing spondylitis & sciatica)

Movement = 2 planes:

1. flex (touch toes) & extend back
2. bend to each side (lateral flexion)

• schober test: measure 10cm above & 5cm below dimples of venus & mark, when patient attempts to touch their toes measure distance between marks, normal flexion would have >5cm change

Neuro/special tests:

• sciatic stretch test: lay patient flat, tell them to keep their leg straight whilst you lift it off the bed & at the same time dorsi flex their foot (push foot upwards towards head) leads to pain which can go down the whole leg past the knee to the foot, suggests sciatic nerve irritation/compression (sciatica)
• femoral stretch test: patient lies on their front, bending the knee causes thigh slight pain, lifting their same leg off the bed exacerbates the pain = indicates femoral nerve compression (L2-L4)

Function:

• watch gait