Back Exam

Prepare patient

  1. Introduction
  2. Position: standing in underwear

Look

General inspection

  1. Obvious other joint disease
  2. Deformity – scoliosis, loss of normal lumbar lordosis/thoracic kyphosis (ank. spondylosis)

Feel

  1. Each vertebrae, SIJs, and para-spinal muscle bulks

Move

  1. Lumbar movements
    1. Forward flexion – touch toes.
      1. Schrober’s test: mark level of L5 (or dimples of Venus). Place one finger ~5 cm below this mark, and a second ~10 cm above this mark. When patient tries to touch toes distance should increase 5cm.
    2. Lateral flexion – slide hand down to touch knees
    3. Extension
    4. Rotation (fix pelvis – e.g. by sitting)

Leg

  1. Straight leg raising (>60º)
  2. Test for radicular pain on dorsiflexing foot at limit of SLR

Function

  1. Full neurological examination of lower limb
  2. Anal tone
  3. Test for saddle anaesthesia
  4. Ask about bladder & bowel problems
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