SPINE

EXAMINATION
AND
SCOLIOSIS

SPINE
EXAMINATION

INSPECTION (LOOK)
1.

GAIT

Normal walking

Walking on tip toe (S1)

Walking on heel (L5)

2. STANDING

a) anterior
- attitude of the neck and head
-torticollis
- any swelling over anterior aspect of neck
- wasting of the muscle of thigh
- lower limbs attitude and deformity
- skin changes
-scars or sinuses

b) lateral
Normal cervical, thoracic and lumbar spine
Gibbus (acute angulation of spine)
Kyphosis
Lordosis

c) posterior
Scoliosis
Listing of trunk
Shoulder tilt
Pelvic tilt
Wasting of muscle
Skin changes over the spine (hair tuft,
pigmentation)
Scar
Sinus
Swelling

PALPATION (FEEL)
Temperature
Tenderness

along the spinal process

Paravertebral muscle spasm
Step deformity
Swelling

MOVE

CERVICAL SPINE

Forward flexion

Extension

Normal : 45 to 60 degrees

Rotation to right

Normal : 45 to 60 degrees

Left lateral flexion

Normal : 45 degrees

Right lateral flexion

Normal : 75 to 90 degrees

Normal : 75 degrees

Rotation to left

Normal : 75 degrees

Thoracic and lumbar spine

Forward

flexion (Schobers test)

Normal : 90 degrees
Extension
Normal : 30 degrees
Lateral flexion to left and right
Normal : 30 to 45 degrees
Rotation to left and right
Normal : 45 degrees

SPECIAL TEST
Cervical spine :

Compression

test
Distraction test
Valsalva test
Swallowing test
Adson test

 COMPRESSION TEST

Press down upon the top of pts

head

If there is increase pain in either

cervical spine or upper extremity,
note its exact distribution. So, we
can locate the neurological level

A narrowing of neural foramen,

pressure on the facet joints or
muscle spasm can cause increase
pain upon compression

 DISTRACTION TEST

Place the open palm of one

hand under the pts chin, and
the other hand is upon occiput
Then, gradually lift (distract)
the head to remove its weight
from the neck
To demonstrate the effect that
neck traction might have help
in relieving the pain by
decreasing pressure on the
joint capsules around the facet
joints.

 VALSALVA TEST

Ask pt to hold his breath and bear down as if

he were moving his bowels

Then, ask whether he feels any increase in

pain and describe the location

This test increase intratechal pressure

If a space occupying lesion, such as a

herniated disc or a tumor present in cervical
canal, pt may develop pain in cervical spine
secondary to increase pressure

The pain also may radiate to the dermatome

distribution of cervical spine pathology

 SWALLOWING TEST

Difficulty or pain upon

swallowing can sometimes caused
by cervical spine pathology such
as :
Bony protuberance
Bony osteophytes
Soft tissue swelling due to
hematomas, infection or tumor
in ant portion of cervical spine

 ADSON TEST
Pull

the arm downwards

Palpate the radial pulse
Turn the pts head to the same side while feeling
the radial pulse
Fading of the radial pulse indicates positive
thoracic outlet obstruction

 Thoracic and lumbar spine

Straight

leg raising test

Sciatic stretch test
Femoral stretch test

 STRAIGHT LEG RAISING TEST

With the knee extended, passively flex

the hip in order to lift the lower limb

The pt will feel pain over the back and

radiating to lower limb.

Watch the distribution of pain

indicating the involved nerve root

Normally accepted positive if the angle

of elevation is <60 degrees

Cross sciatic tension indicate severe

root irritation

SCIATIC STRETCH TEST

Following the SLR test, drop the

limb for about 10 degrees to
relieve tension on the irritated
nerve root

Dorsiflex the ankle to reproduce

the stretching effect on the nerve
root

This will reproduce the sciatica

pain

FEMORAL STRETCH TEST

look

for lumbar root tension

ask the patient to lie prone
flex the knee
lift up the hip into extension
pain may be felt in front of the thigh and the
back
Done to exclude higher disc prolapsed (rare)

NEUROLOGICAL
EXAMINATION

UPPER LIMB
Tone
Power

Nerve root

Test

C5

Elbow flexion

C6

Wrist extension

C7

Wrist flexion

C8

Finger flexion

T1

Finger abduction

 Reflexes
Biceps

(C5-6)
Brachioradialis
Triceps (C7-8)
Sensation
Upper limb
C5
C6
C7
C8
T1
T2
-

lateral forearm
lateral forearm
thumb and index finger
middle finger
ring and little fingers
medial forearm
medial elbow
distal half of the medial arm
proximal half of medial arm

LOWER LIMBS
Tone
Power

L1,2

Hip flexion

L3,4

Knee extension

L4

Dorsiflexion

L5

Great toe
extension

S1,2

Plantarflexion

 Reflexes
Knee

jerk (L3-4)
Ankle jerk (S1-2)
Babinskis reflex

Clonus
Sensation

Lower limb
L1

L2

L3

L4

L5

S1
S2

S3,S4,S5

groin
anterior thigh
anterior knee
medial aspect of
leg
lateral aspect of
leg
dorsal aspect of
foot
lateral aspect of foot
posterior aspect leg
and thigh
perianal region

SCOLIOSIS

SCOLIOSIS
Definition

: Lateral curvature of the spine

2 broad types of deformity are defined:
Postural

scoliosis
Structural scoliosis

Postural scoliosis
The

deformity is secondary or compensatory to

some condition outside the spine.
Short

leg
Pelvic tilt due to contracture of the hip

Local muscle spasm a/w PID may cause a

skew back (sciatic scoliosis)
The curve disappear when the patient sit or on
forward flexion.

Structural scoliosis
Usually

accompanied by bony abnormality or

vertebral rotation.
The deformity is fixed and does not disappear
with changes in position.
Causes:
Idiopathic

(most cases)
Osteopathic (congenital)
Neuropathic ( poliomyelitis, cerebral palsy)
Myopathic ( muscular dystrophies)
Neurofibromatosis

IDIOPATHIC SCOLIOSIS
Constitutes

about 80% of all cases of scoliosis

Age of onset have been used to defined 3
groups:
Adolescent

( 10 y/o ) - commonest
Juvenile ( 4 - 9 y/o )
Infantile ( 3 y/o )

ADOLESCENT IDIOPATHIC
SCOLIOSIS
Commonest

type
Occur mostly in girls
Usually present at the age of 10 15 y/o

CLINICAL FEATURES
Symptoms:
Deformity

(skew back, rib hump)

Signs:
Deviation

of the spine from the midline (right thoracic

curves are the commonest)
Does not disappear with flexion
The hip sticks out on the concave side
Breast and shoulder may be asymmetrical
Asymmetrical rib hump on the convex side (thoracic
scoliosis)

X-RAY
Full

length PA and lateral view of the spine and

iliac crest must be taken with the patient erect.
Angle of curvature is measured (Cobbs
angle)

X-RAY
Rissers

sign is identified.
(skeletal maturity)

TREATMENT

Conservative treatment
Exercise

Have no effect on the curve but help to maintain muscle

tone

Bracing
Is used for
All progressive curves over 20 but less than 40
Well balanced double curve
With younger children needing operation, to hold the curve
stationary until they reach adolescence

To prevent recurrence after spinal fusion

Milwaukee brace

Boston brace

 Operative
Indicated

treatment

for curves > 40

Type of surgery:
The Harrington system
Rod and sublaminar wiring
Posterior or anterior instrumentation

THANK YOU