7. ii. Increased kyphosis (posterior convexity of the spine) > senile kyphosis (with osteoporosis, osteomalacia or pathological fracture) > Scheuermann’s disease (osteochondritis involving one or more of the vertebrae) > ankylosing spondylitis
8. iii. Gibbus (angular kyphosis) > fracture > tuberculosis of the spine > congenital abnormality
9. iv. Lumbar curvature > flattening or reversal of lumbar lordosis : - prolapsed intervertebral disc - osteoarthritis of the spine - infection of vertebral bodies - ankylosing spondylitis > increase in lumbar lordosis - may be normal (esp. in women) - spondylolisthesis - secondary to increased thoracic curvature or to flexion deformity of the hips
10. (b) Look from behind i. listing of trunk (due to muscle spasm) ii. Scoliosis (lateral curvature of spine) - postural : scoliosis disappears with forward flexion of the spine - structural : scoliosis persists with forward flexion of the spine and a rib hump presents iii. Shoulder tilt iv. Pelvic tilt
11. v. Skin changes over the spine - hair tuft (spina bifida) - sinus - colour changes or pigmentation (neurofibroma) - scar vi. Swelling vii. Prominent crease of the trunk viii. Wasting of glutei, hamstrings and calf muscles
19. Anchor the top of the tape with a finger and ask the patient to flex as far as he can
20. Measure the increase in the distance between the 2 points which indicate lumbar excursion
21.
22. 2. Extension - ask the patient to arch his back - assist him by steadying the pelvis and pulling back on the shoulder - normal : 30°
23. 3. Lateral flexion - ask the patient to slide the hands down the side of each leg in turn - record the point reached from the floor or - measure the angle - normal : 30-45°
24. 4. Rotation - patient seated to fix the pelvis or pelvis fixed by examiner - ask the patient to twist round to each side - normal : 45°
25. Cervical spine Flexion - ask the patient to bend the head forwards - chin should be able to touch the chest - normal : 80°