Exam - Back

From CambridgeNotes

Preparation and planning

  • Expose patient completely except for boxer shorts or equivalent (i.e. to see back and legs)

Look

  • Ask patient to walk
  • Look from side and then back

Feel

  • Feel spine and paraspinal areas; feel for sacro-iliac tenderness (ankylosing spondylitis)

Move

  • Lumbar: assess flexion (Schober’s test: mark 5cm below and 10cm above L4 → increases 5cm on flexion); assess extension; assess lateral flexion
  • Consider thoracic rotation; Cervical neck flexion, extension, lateral flexion, and rotation

Function

  • Sciatic: Straight leg raise to elicit pain (then flex ankle to make worse! flex knee to make better (bow-string test); if both legs raised pain shouldn’t be elicited
  • Femoral: Hip extension elicits pain (then knee flexion)

Neurovascular

  • Test tone, power, reflexes, co-ordination and sensation of lower limbs (best test of power is standing on tip-toes or balls-of-feet); offer to test perineum including perianal sensation, anal sphincter tone
  • Assess lower limb circulation

Others

  • Offer abdominal exam (abdominal aortic aneurysm) and digital rectal exam (prostate)
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