PHYSICAL EXAMINATION

THE SPINE

ANATOMY

COLUMNA
VERTEBRALIS

5 regions, 33 bones
Regions
Cervical ( 7
vertebrae)
Thoracic ( 12
vertebrae)
Lumbar ( 5 vertebrae)
Sacral bone (5 fused
= Sacrum)
Coccygeal bone (4
fused = coccyx)

THE VERTEBRAL
COLUMN
Vertebrae
separated by
intervertebral
discs
Intervertebral discs
(anulus fibrosus +
nucleus pulposus)

VERTEBRA
Typical vertebra has :

Corpus vertebra
Arcus vertebra (lamina and pedicle)
Foramen vertebra
Processus spinosus (1)
Processus transversus (2)
Processus articularis superior (2)
Processus articularis superior(2)

CERVICAL VERTEBRAE

THORACIC AND LUMBAR

VERTEBRAE

Modified from Fig. 7.18

SACRUM AND
COCCYX

CERVICAL EXAMINATION

INSPEKSI

SYMMETRY/
ASYMMETRY
DEFORMITY
TORTICOLIS

PALPATION
STEPS ONE

Tenderness
Tumor mass

STEPS TWO

Palpate the lateral

aspects of the
vertebra

STEPS THREE

Continue palpation into

the supraclavicular fossa

STEPS FOUR

Examine the anterior

aspect of the neck

MOVEMENT
STEPS ONE

Flexion
Ask the patient to bend
the head forward

STEPS TWO

Extension
Ask the patient to till
the head backward

STEPS THREE

Using a spatula in the

clenched teeth as a
pointer. Then ask the
patient to flex the head
forward. Normal range
= 80

STEPS FOUR

Ask the patient to

extend the head.
Normal range = 50
The total range in the flexion and extension
planes should be assessed. Normal range
= 130

STEPS FIVE

STEPS SIX

Lateral flexion
Ask the patient to tilt
his head on to his right
shoulder

Laterral flexion
For accurancy, using a
spatula as a pointer.
Normal range = 45

STEPS SEVEN

If lateral flexion cannot

be carried out without
forward flexion, this is
indicative of pathology
involving the
atlantoaxial and
atlanto-occipital joints.

STEPS EIGHT

Rotation
Ask to ptient to look
over the shoulder.

STEPS NINE
Rotation
Again a spatula use a
pointer. Normal range
= 80

THORACAL PHYSICAL
EXAMINATION

INSPECTION

PALPATION

PERCUSSION

MOVEMENT

MOVEMENT FLEXION
Schobers method : a
10 cm length of
lumbar spine is used
as a base, where a
15 cm length of
spine is employed.
Begin by positioning
a tape measure with
the 10 cm mark level
with the dimples of
Venus (which mark
the posterior
superior iliac spines).

MOVEMENT FLEXION
Anchor the top of
the tape with a
finger and ask the
patient to flex as
far forward as he
can.

MOVEMENT FLEXION
Flexion in the
thoracic spine may
be measured with
the upper point 30
cm from the
previous zero
mark.

MOVEMENT EXTENTION
patient arches his
back, assisting him
by steadying the
pelvis and pulling
back on the
shoulder

MOVEMENT LATERAL FLEXION

measure the angle
formed between a
line drawn through
T1, S1 and the
vertical

MOVEMENT ROTATION
The patient should
be seated, and asked
to twist round to
each side. Rotation is
measured between
the plane of the
shoulders and the
pelvis. The normal
maximum range is
40 and is almost
entirely thoracic

SUSPECTED THORACIC CORD

COMPRESSION
Use a blunt object
such as the handle of
a tendon hammer to
stroke the skin in each
paraumbilical skin
quadrant.
Failure of the
umbilicus to twitch in
the direction of the
stimulated quadrant
suggests cor
compression on that
side at the appropriate
level

SUSPECTED THORACIC MOTOR ROOT

DYSFUNCTION
Beevors sign
The patient places his
hands behind his
head, flex his knees,
and sit up
See the movement of
the umbilicus to one
side (and up or down)
suggests that the
abdominal muscles on
that side are
unopposed i.e. there
is weakness on the
opposite side

SUSPECTED ANKYLOSING SPONDYLITIS

Check the patients
chest expansion at
the level of the 4thn
interspace
Less than 2.5 cm is
regarded as highly
suggestive of
ankylosing
spondylitis

Lumbal Examination

Inspection

Palpation

Percussion

Movements

PHYSICAL EXAMINATION

INSPECTION

PALPATION

PERCUSSION

MOVEMENTS

SACRAL SPARING