Clinical examination of the spine by Jwalant Mehta

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• Clinical examination of the Spine

Jw alant S. Mehta MBBS, MS (Orth), D Orth, MCh
(Orth), FRCS (Tr Orth) Consultant Spine
Surgeon The Royal Orthopaedic Hospital Spire
Parkway Hospital BMI The Priory and Edgbaston
Bromsgrove Private Clinic
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General aspects

• Introduction
• Consent to examination
• Non-verbal communication (eye contact)
• First impressions
• Exposure comfort (warm hands and room)
• Inflicting pain

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Standing un-supported

• Shou lders, Pelvis
• Muscle contours
• Sp inal contours
• Limb lengths

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Standing side profile

• Forward stoop
• Hips and knees
• Forward gaze
• Sp inal contours

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Range of motion

• Range
• Rhythm
• Extremes of range
• Pain

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Flexion of the trunk

• General flexibility
• Getting up to neutral
• Discogenic painful

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Extension of the trunk

• Facet loading
• Disc prolapse / stenosis
• Sp ondylolysis
• 1 leg hyper-extension

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Cervical spine range examination
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Pain

• Sym ptom reported by the patient
• Tenderness
• Midline
• Gentle thump
• Segm ental rotation
• Muscle spasm, tender points

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Neurology

• Motor (grades, through the full range of the
  joint)
• Sensations (all modalities)
• Reflexes (deep, superficial and pathologic)
• ASIA charts
• Document with date

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Upper limb neurological exam
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Lower limb neurologic examination
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Deep tendon reflex

• Grading
• 0 absent
• 1 hypoactive
• 2 normal
• 3 hyperactive
• 4 hyperactive with clonus 5 sustained clonus
• Compare with opposite side

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Deep tendon reflex
Stretch reflex Contraction in response to
stretch of muscle spindles (receptors in
parallel to muscle fibres. 2 neutron arc.
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Superficial abdominal reflex
Motor response to skin stimulation. Poly-synaptic
response. Peripheral sensory nerve ascending
sensory tract brain descending motor tract and
muscle. Present absent or asymmetric.
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Babinski reflex
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Hoffmans reflex
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Inverted radial reflex
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Sacro-iliac joints

• Stable joint
• Referred pain
• Tenderness
• Stressing joint
• Inflammation, inju ry

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Waddells non-organic signs

• Tenderness superficial non-anatomic
• Sim ulation of pain axial load rotation
• Distraction straight leg raise
• Regional motor sensory
• Over-reaction

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Ancillary examination

• Shou lder examination
• Hip examination
• Peripheral nerves and Brachial plexus
• Distal pulses

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Peripheral nerves

• Tinels sign over the course of the nerve
• Phalens test for Carpal tunnel syndrome
• Neurological examination (sensations, motor)
• Median nerve Ulnar nerve in upper limb

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Thoracic outlet
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Contact us

• Royal Orthopaedic Hospital
• BMI The Priory Hospital
• Spire Parkway Hospital
• Bromsgrove Private Clinic

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Contact and Connect

• Clinical secretary Samantha Leavy 44 785 021
  1939
• Medico-legal secretary Jan Clarke 44 121
  4508928
• Spire Parkway Hospital0121 704 5500
• BMI NEC (National Enquiry Centre) 0808 101 0337
• Email info_at_mehtaspine.co.uk
• The appointments are booked through the clinic