Spine Exam (Back & Neck)

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or reduced range of movement in the back	0	1
Asks if patient has had previous trauma to the back, is waking up at night with pain, neurological symptoms or bladder/bowel dysfunction	0	1	2
Washes hands	0	1
Exposes patient fully and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Asks patient to walk to the end of room and turn	0	1
Comments on patient’s speed, the phases of walking, stride length and arm swing	0	1	2
Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity	0	1
Inspects back for wasting of muscles (trapezius, paraspinal, gluteal, calf), scoliosis, skin changes, scars, hindfoot deformities	0	1
Inspects sides for fixed flexion deformities and increased kyphosis or lordosis	0	1
Inspects back for shoulder/hip/knee alignment, kyphoses and lordoses, scoliosis, scars, skin changes, wasting of muscles (trapezius, paraspinal, gluteal)	0	1	2
Feels for temperature, tenderness and alignment of the spinal processes	0	1
Feels for tenderness and tone of the paravertebral muscles	0	1
Assesses cervical flexion, lateral flexion, rotation and extension	0	1
Whilst standing checks for spinal flexion using the modified Schober’s test and lateral flexion	0	1	2
Supports body whilst checking for extension of the back	0	1
Asks patient to sit down to assess thoracic rotation	0	1
Assesses chest expansion	0	1
Performs straight leg raise for testing sciatic nerve, femoral stretch test for the femoral nerve, Faber’s test for sacroilitis	0	1	2
Offers examination of shoulder and hip, neurovascular exam and history	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

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