Spine History and Physical Exam
History
Inspection
- posture, position of head
- C spine lordosis, thoracic kyphosis, lumbo lordosis
- scoliosis - can be brought out with patient bending forward
- can be compensation for leg length discrepancy - have patient sit down to check
Palpation
- spinous processes (C7 is prominent one on back)
- paravertebral muscles with patients prone - helps them relax)
Range of Motion
C spine
- flexion/extension
- rotation
- lateral flexion
Rest of spine
- rotation (have patient seated to aviod hip swivels)
- flexion/extension
- lateral bending
Special Tests
- spinal nerve root testing
- Spurling's maneuver - lateral neck flexion and compression can lead to pain in a dermatome, suggesting cervical nerve root impingement
- straight leg raising: passive leg flexion with knee extension: positive sign is pain down leg in dermatome distribution - L5 or S1 nerve root impingement
- femoral stretch (psoas sign): with person prone, bend knee at 90 degrees and extend leg - pain suggests L4 nerve root impingement
- Schober's test: measures movement of lumbar spine: mark 10 cm above dimples of Venus, have patient try to touch toes, measure distance between marks - should have increased to 14-15 cm.
- Faber test: flexion, abduction, external rotation - pain suggestions SI joint problems