Examination of the Adult Spine

Mark Galloway, PA

Objectives

• Know how to obtain an appropriate and complete patient history

• Know how to perform physical examination as related to the spine

• Develop an understanding as to when to continue care vs. referring to a specialist

Chief Complaint

Determine:

Axial symptoms: neck pain, mid-back pain, low back pain

Radicular symptoms: numbness, tingling, shooting pains in UE, LE, or chest wall

Myelopathic symptoms: weakness, muscle wasting

History

• When did symptoms begin

• Trauma vs. insidious onset

• Is this work related

• Any previous spinal injury/condition - if yes, treatment and response to treatment

• Any bladder or bowel dysfunction

• History of diabetes or TB

• Do symptoms cause sleep disturbance

• Unexplained weight loss

Imaging Studies

• Xrays: four views

• MRI

• CT Scan, if indicated (ie: pacemaker, heart implant)

Inspection

• Observe gait/station: antalgic, trendelenburg, etc.

• Observe spine from behind for: asymmetry, scoliosis, scars, café au lait spots, muscle wasting/atrophy, hair tuft (spina bifida), scapular winging, kyphotic hump

• Observe from the side for normal curvatures: cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral kyphosis

Physical Examination

• Palpate spinous processes/paravertebral muscles /SI joints for tenderness

• Range of motion normals: Normal Cervical Lumbar

Flexion 80 80 – 90 Extension 50 30 Lateral rotation 80 45 Lateral bending 45 30 – 45

• Sensory: light touch & pin prick in all dermatomal distributions, and two point discrimination if indicated

• Basic Tests

Cervival: Spurlings maneuver, Lhermitte's

Sign

Lumbar: SLR positive >60o, Sciatic Stretch,

Femoral Stretch, Schober Test, FABER - SI

Babinski, Clonus

Motor

Malingering/Non-organic Back Pain

Hoover Test

When to Refer

When to Refer

• When conservative treatments fail, ie: NSAIDS, physical therapy, alternative therapy

• Condition continues to effect activities of daily living

• Prolonged radicular symptoms

• Any evidence of myelopathic process

Questions