Spine Exam (Back & Neck)

May 29, 2016 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Asks if patient suffers from pain, stiffness or reduced range of movement in the back
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Asks if patient has had previous trauma to the back, is waking up at night with pain, neurological symptoms or bladder/bowel dysfunction
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Washes hands
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Exposes patient fully and asks them to stand
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General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)
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Asks patient to walk to the end of room and turn
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Comments on patient’s speed, the phases of walking, stride length and arm swing
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Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity
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Inspects back for wasting of muscles (trapezius, paraspinal, gluteal, calf), scoliosis, skin changes, scars, hindfoot deformities
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Inspects sides for fixed flexion deformities and increased kyphosis or lordosis
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Inspects back for shoulder/hip/knee alignment, kyphoses and lordoses, scoliosis, scars, skin changes, wasting of muscles (trapezius, paraspinal, gluteal)
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Feels for temperature, tenderness and alignment of the spinal processes
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Feels for tenderness and tone of the paravertebral muscles
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Assesses cervical flexion, lateral flexion, rotation and extension
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Whilst standing checks for spinal flexion using the modified Schober’s test and lateral flexion
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Supports body whilst checking for extension of the back
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Asks patient to sit down to assess thoracic rotation
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Assesses chest expansion
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Performs straight leg raise for testing sciatic nerve, femoral stretch test for the femoral nerve, Faber’s test for sacroilitis
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Offers examination of shoulder and hip, neurovascular exam and history
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Thanks patient and offers help to redress
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Washes hands
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Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)
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Summarises appropriately with only key findings
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Offers appropriate differential diagnoses
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