Physical Examination of The Spine

IK, DN, WH, RA, RI, TN

ANATOMI TULANG VERTEBRA
ANATOMI TULANG VERTEBRA THORAKOLUMBAL
 GENERAL PRINCIPLES
Patient seated
Examiner stands in front & then behind the
patient
Exposure includes the neck region, upper
chest & both upper limbs
Cervical Spine

INSPECTION
1. ANTERIOR :
a. Attitude of the neck & head :
b. Prominent sternocleidomastoid muscle
c. Skin changes : scars or sinuses, inflamation, Surgical scars located on the anterior
aspect of the neck usually indicate a previous spine or thyroid surgery.

2. LATERAL :
a. Loss of lordosis
b. Swelling
c. Skin changes

3. POSTERIOR :
a. Prominent trapezius muscle
b. Wasting of muscles
c. Swelling
d. Skin changes
e. Prominent spinal processes
 PALPATION
1. TEMPERATURE
2. TENDERNESS
3. MUSCLE SPASM
4. SWELLING
5. TO IDENTIFY THE SPINAL LEVEL, FEEL FOR
THE MOST PROMINENT SPINOUS PROCESS
OF T1
RANGE OF MOVEMENT
FORWARD FLEXION
Normal : 75 to 90O
Chin should be able to touch the chest
EXTENSION
Normal : 45O

RIGHT LATERAL FLEXION

Normal : 45 to 60O
LEFT LATERAL FLEXION
Normal : 45 to 60O

ROTATION TO RIGHT
Normal : 75O
ROTATION TO LEFT
Normal : 75O
Thoracic Spine
Inspection ( Look )
- From Posterior to evaluate the Spine Curvature

Postural Scoliosis Structural Scoliosis

- Shoulder tilt
- Rib hump
- Skin change : Sinus, Lump, Colour changes or pigmentation Neurofibroma
Bend to forward
To know Postural or Structural Scoliosis

Rib Prominence (+) Structural Scoliosis

Plumb Line
From the C7 Spine Process
To th S1 or natal cleft normal
 Flat Back Deformity

Scheurmanns
Khyposis

Flexion deformity
Ankylosing Spondylitis
- From lateral to evaluate the Khypotic deformity

Normal Khypotic of the Thoracic

In Cobb angle is 21 to 33 degree
 Palpation

- Along the spinal process

- Temperature
- Tenderness
- Swelling
- Step deformity
- Gibbus
- Paraspinal Spasm
 Range of Motion

- The Thoracic Spine permits little motion.

Normal Active Thoracic Flexion Active Thoracic Extension

Apparent Change in Length

Between Vertebra Prominens and Sacrum with a tape measure

when the patient standing erect and forward bending
(+) Increase the distance between vertebral spine
Modified Schoeber test

Mark 10 cm above and 5 cm below the Posterior superior iliac spine = total 15 cm
Long. instruct to flexion normally > 5 cm increase
If , 5 cm indicate organic spinal pathology
 Chest expansion

The distance between these two measurements should be

about 5 cm.If 2.5 cm chest expansion is decreased
Dermatome of the cervical and thoracal
- Beevors Sign used to screen for
asymmetric loss of thoracic root motor
function
Half sit up with knees flexed
And the arms behind the head
Symmetric coordinated
abdominal muscle contraction
should keep the umbilicus in
the midline
If not symmetric the umbilicus
To deviate the stronger
uninvolved side
Abdominal muscle reflexes
- May be tested as a method of screening for
thoracic spinal cord compression
- Stroke the handle of reflex hammer across the
abdomen, beginning at the umbilicus
abdominal musculare involuntary cotract
Lumbar Spine

Inspection

- Examine his gait

- Skin discoloration
- Birth marks
- Open sinus drainage
- Abnormal Swelling
- Pelvic Obliquity
- Leg lenght discrepancy
- Slight lordosis lumbar
 Palapation
Bony Palpation
Anterior Aspect
- Anterior Superior Iliac Spine
- Iliac Crest
- Iliac Tubercle
- Greater Trochanter
- Pubic Tubercle
Porterior Aspect
- Spinous Process
- Posterior Aspect of the Coccyx
Posterior Aspect
Anterior Aspect
Soft Tissue Palapation
- Supraspinous and Interspinous ligament
- Paraspinal muscle
- Tenderness
- Anterior abdominal muscle
- Inguinal Area
Range of Motion

Lumbar Flexion + 10 cm to the Lumbar Extension 20 to 30 degree

Floor
Lateral bending about 20 30 degree
Rotation
Gait test
- Heel walking test : for test the weakness of L4 that
innervated the Tibialis anterior muscle

If ( - ) Weak in HNP L3 L4
- Toe walking test : to evaluate S1 innervated
Gastrocsoleus muscle group
weak in HNP L5 S1
Neurologic Examination
T12, L1, L2, L3 Levels
Muscle testing : Iliopsoas
Sensation : Anterior thigh, inguinal, knee joint
L2, L3 , L4 Levels
Muscle Testing : Quadriceps femoral nerve
Adductor Obturator nerve
L4 level
Muscle Testing : Tibialis anterior deep peroneal
Reflex testing : Patellar reflex
Sensation : Medial side of the leg
L5 level
Muscle testing : Extensor Hallucis Longus
Reflex testing : none
Sensation : lateral leg and dorsum foot
S1 level
Muscle testing : Peroneus longus and brevis
Reflex testing : Achilles tendon reflex
Sensation : Laeral malleolus and lateral plantar
surface
S2, S2, S3 level
- Supply for the bladder, intrinsic muscle of the foot, no
deep reflex, sensation around the anus
- Superficial reflex : Abdominal, cremaster, anal
THANK YOU
Myotome
C3,4 and 5 supply the diaphragm (the large muscle between the
chest and the belly that we use to breath).
C5 also supplies the shoulder muscles and the muscle that we use
to bend our elbow .
C6 is for bending the wrist back.
C7 is for straightening the elbow.
C8 bends the fingers.
T1 spreads the fingers.
T1 T12 supplies the chest wall & abdominal muscles.
L2 bends the hip.
L3 straightens the knee.
L4 pulls the foot up.
L5 wiggles the toes.

S1 pulls the foot down.

S3,4 and 5 supply the bladder. bowel and sex organs and the anal
and other pelvic muscles.