Introduction
- Wash hands (and don PPE if needed)
- Introduce yourself (name and role)
- Confirm patient’s name and DOB
- Explain what the examination involves
- Gain consent to continue
- Ask if patient in any pain before continuing
Look
- Observe the patient from behind to look for any scoliosis
- Then ask the patient to turn to the side to look for any exaggerated thoracic kyphosis or loss of normal lumbar lordosis.
Feel
- Palpate the vertebrae and sacroiliac joints for alignment and tenderness
- Then palpate the para-spinal muscles for tenderness or tightness
Move
- Lumbar flexion and extension - place 3 fingers over the lumbar spine and ask the patient to bend forward as much as possible. Fingers should move apart
- Lumbar lateral flexion - ask patient to run their hand down the side of their leg
- Thoracic rotation - ask patient to cross their hands and then twist their shoulders side to side
Special tests
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Straight leg raise - ask the patient to go back onto the bed and lie it flat. Then raise one leg at a time - this will exacerbate nerve root irritation and dorsiflexion will further show this (sciatic nerve L3, L4, S1)
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Patella (L3,L4) and ankle jerk reflexes (S1, S2)
-
Babinski response for upper motor neurone lesions
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Dorsiflexion of big toe (L5 nerve root)
To Complete the Exam
- Explain to the patient that the examination is now finished.
- Thank the patient for their time.
- Dispose of PPE appropriately and wash your hands.
- Summarise your findings.