Clinical Examination

 

Inspection:

1.  Posterior - Note any skin changes / Scars / Paraspinal muscle bulk and symmetry / Pelvic obliquity / Deformity (Scoliosis / List)

2.  Lateral - Note normal triple curvature of the normal spine / Deformity (hyperlordosis / loss of lordosis / kyphosis).

3.  Gait

 

Palpation:

  • Important to orientate yourself to the different levels of the spine.
  • This can be done by identifying the location of the interspace between L4 and L5 spinous processes by drawing an imaginary line between each iliac crests
  • Once you are orientated palpate the following land marks:
     

1.  Bony prominences - Individual spinous processes.

2.  Sacroiliac joints.

3.  Paraspinal muscles.

 

Movement:

1.  Cervical spine.

2.  Thoracic spine.

3.  Lumbar spine.

  • The motion of the lumbar spine is a result of a complex interaction the bony articulations and soft tissues of the lower back. 

 

 Flexion:

  • Most of the forward flexion is caused by movement at the hips.
  • There is a large amount of lumbar flexion variation in the population and with age.
  • The patient is asked to flex forward and the distance of the patient’s fingers from the floor gives an indication of the degree of flexion available.
  • The Modified Schobers test is used to assess for lumbar spine flexion in isolation.
  • A normal value in Schobers is an increase of more than 5 cm of flexion.

 

Extension

  • Patient is asked to lean backwards as far as possible.
  • Degree of movement is quantified by estimating the angle between the truck and a vertical line.
  • Normal: 20 - 30 degrees.

 

Lateral Flexion ( 1 , 2 )

  • Assessed by asking the patient to lean as far to each side as possible.
  • Movement is actually a combination of lateral and rotational movements.
  • Difficult to measure but may be estimated by drawing a line between the vertebral spinous processes and a line bisecting the sacrum.
  • Look for asymmetry, a common finding in herniated discs.

 

Rotation ( 1 , 2 )

  • Little or no rotation can be demonstrated on clinical examination of the lumbar spine.

 

Neurological Tests of the Lower Limbs

1.  Motor examination 
2.  Sensory
3.  Reflexes

Knee
Ankle

 4.  Nerve Root Impingement Tests

Straight Leg Raising
Lasegue’s Test
Bowstring Test
Femoral Nerve Stretch Test

 

Other Examinations