Spine examination
Suitably undressed, usually down to underwear. Start with the patient standing, then lying prone and finally lying supine.
1. STANDING
Look
- Scars: previous surgery
- Lumps: abscess, tumour (e.g. sacral lipoma), prominent paravertebral muscle spasm
- Sinuses: deep infection
- Cafe au lait spots / nodules: Neurofibromatosis
- Hairy patch (spinal dysraphism)
- Mongolian blue spot (more common in Asians: no clinical significance)
- Low hairline due to short neck: Klippel-Feil syndeome: fusion or absence of cervical vertebrae; may be associated with Sprengel shoulder (undescended scapula)
- Down / Morquio syndromes: Atlanto-axial instability
- Asymmetry of shoulder height / trunk balance / loin crease: scoliosis (lateral curvature with rotational deformity of vertebral bodies)
- Leg length discrepancy (check level of iliac crests)
- If patient consistently stands with one knee bent in spite of equal leg lengths, this may indicate nerve root tension, as knee flexion relieves the pull on the nerve root(s)
- Lateral deviation of spine (known as 'list' or 'tilt'): may be a sign of prolapsed intervertebral disc causing nerve root ompression
- Associated anomalies of hands/feet, e.g. syndactyly, pes cavus: may be part of a syndrome
- Kyphosis and lordosis (best assessed from side): may be exaggerated or reduced
- Round backing / hunched shoulders: Schuermanns disease/kyphosis
- Gibbus (aka kyphos): acute angular deformity with bony prominence, e.g. tuberculous vertebral collapse
- Observe gait
Feel
- Tenderness: may be bony, intervertebral or paravertebral
- Bony prominence or steps
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