6. Before starting …….
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Introduce yourself
Ask permission to perform examination
Explain the patient appropriately –
The patient must be exposed properly
Tell the patient to let you know if anything
you do Is uncomfortable or painful .
• When female patient – make sure that
female nurse or assistant is present.
7. Clinical examination of spine
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History
General examination
Inspection = look
Palpation = feel
Movements and measurements
Special tests
Neurology
21. Inspection
Posteriorly
Position of head
Level of hair line
Length of neck
Level of shoulders
Level of scapulae
Deformity – scoliosis
Margin of trunk
Spinous processes
Iliac crest
Dimple of venous
22. Paraspinal muscle spasm or not
Any swelling- lipoma
cold abscess Renal angle
Skin- dimple; hair tufts; nevus; scar; sinus;bed
sores
café-au- lait spots Step
Abnormal trunk furrows
Apparent shortening of lower limbs
Pelvic obliquity
27. PALPATION
Local rise in temperature
Palpate all spinous process
Prominent spinous process
and its significance.
Tenderness ( occiput to coccyx)
Direct pressure
Twist tenderness
Deep thrust tenderness
Anvil test
28. Structure
Landmark
Cervical vertebral bodies
Same level as spinous processes
C1 transverse process
One finger’s breadth inferior to mastoid process
C3-C4 vertebrae
• .
C4-C5 vertebrae
Posterior to hyoid bone
C6 vertebrae
Posterior to cricoid cartilage; moves during flexion and
extension of cervical spine
C7 vertebrae
Prominent posterior spinous process
T1 vertebrae
Prominent protrusion inferior to cervical spine
T2 vertebrae
Posterior from jugular notch of the sternum
T3 vertebrae
Even with the medial border of the scapular spine
T7 vertebrae
Even with the inferior angle of the scapula
L3 vertebrae
Posterior from the umbilicus
L4 vertebrae
Level with the iliac crest
L5 vertebrae
Typically demarcated by bilateral dimples, but variable
from person to person
S2
At level of the posterior superior iliac spine
Posterior to thyroid cartilage
29. Paraspinal muscle spasm/tender
Step or deformity – level and no.
Any swelling
Cold abscess –
Site
renal angle ,
petit’s triangle ,
iliac fossa
size
Margin
Consistensy
Fluctuation
lymphnodes
41. Special tests :
Lumbar root tension test :
SLRT
MODIFIED LASEGUE TEST
REVERSE SLRT - FNST
FRAJARZTANZ TEST - BRAGGARD SIGN
BOWSTRING TEST
Well leg SLRT
44. SLRT: Technique
• Look at patient face
• Ask if the maneuver produces
Back pain
Leg pain
• Radiating pain/ paraesthesias are
highly suggestive of Disc prolapse
• Measure the angle at which pain
just starts appearing.
• Normally SLR is possible up to 8090°.
45. SLRT: Technique
• If patient cannot lie supine then
this is done in lateral position
as in severe kyphosis.
46. SLRT: Interpretation
Pain
•upto 35° is diagnostic of
intervertebral disc prolapse.
•From 35-70° is suggestive of
disc prolapse.
•beyond 70° is equivocal.
47.
48. Other Uses of SLRT
• Assessing:
– stability of hip joint (ACTIVE SLRT).
– Integrity of hip flexors.
– Quadriceps mechanism of the knee.
49. Fajersztajn test- Braggards
sign
• Technique: SLRT is done to the point
where the symptoms are produced then
the limb is slightly lowered and the
ankle is dorsiflexed.
• If this reproduces the pain then test is
considered positive and Braggards sign is
present.
• It is again highly indicative of prolapsed
intervertebral disc and helps differentiate
from the other pathologies
50.
51. Modified Lasègue test
• With the patient supine, hip and
knee are gently flexed to 900
• The knee is then gradually
extended which reproduces the
symptoms of sciatica.
• Helps differentiate from the hip
joint pain.
53. Cross SLRT
• Also known as Well leg raising test or
Cross over sign
• Technique:
– Patient is supine.
– Examiner performs a SLR on the patient's
unaffected leg to 75º or until it produces pain
down the affected leg .
• Pathognomic of Disc prolapse
• Indicates presence of medial disc
54. BOW STRING TEST
• After positive SLRT , the knee is flexed.
• Test is positive if the patients pain resolves
with flexion at the knee.
• Pain may be re-induced without extending
the knee by pressing on the lateral popliteal
nerve behind the lateral tibial condyle, to
tighten it like a bowstring
• If pain persists this is suggestive of hip
pathology.
58. • TEST FOR SI JOINT :
• FABER Test [Patrick Test]
• Compression Test
• Distraction Test
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Thigh Thrust Test
• Gaenslen’s Test
• Pump handle test
• Gille’s test
65. Sensation
C5 – lateral arm
C6 – lateral forearm
- thumb & index finger
C7 – middle finger
C8 – ring&little finger
T1 – medial arm
66. Sensation
L1 – groin
L2 – anterior thigh
L3 – anterior knee
L4 – leg ant.
L5 – lateral leg
- medial of foot 1st web space
dorsum
S1 – lateral of foot dorsum
- heel and foot sole
S2 – posterior leg and thigh
It is important to have good knowledge of anatomy
before examining the spine .
Spinal cord – foramen magnum to L1
Conus medullaris – terminal portion of spinal cord
Filum terminale – fibrous extension of pia mater anchors cord to coccyx
Cauda equina – collection of nerve roots at the end of vertebral canal
