Physical Examination of Back Spine

Dr. Harun Ar Rashid, MD - Arthritis, Bones, Joints Pain, Trauma, and Internal Medicine Specialist Dr. Harun Ar Rashid, MD - Arthritis, Bones, Joints Pain, Trauma, and Internal Medicine Specialist
0 Views
Rx Musculoskeletal System (A - Z)

Physical examination of the back spine should be completed in all patients with low back pain. A systematic approach to the physical examination is crucial to the correct diagnosis and treatment of the patient and could significantly affect the potential outcome. A complete examination of the lumbar spine should include the following: inspection, palpation, range of motion, flexibility, muscle strength, sensory examination, reflexes, provocative maneuvers, as well as an examination of gait. One must remember that the physical examination should always be used as an adjunct to a patient’s history, and together they should guide the development of a differential diagnosis and treatment plan.

Introduction

Follows the IP-PASS examination methodology

  • Inspection
  • Palpation
  • Passive Range of Motion
  • Active Range of Motion
  • Strength & Neurovascular
  • Special Tests

Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
  • Swelling
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Areas of emphasis for back exam
    • Evaluate for lordosis, kyphosis, scoliosis
    • Leg length discrepancy
    • Overall posture

Anterior inspection – With the anterior inspection, the examiner must begin with the head. The position of the head should be symmetrical on the shoulders. The shoulders are usually equal in height; although in many people, especially overhead athletes, the dominant shoulder is slightly lower. The anterior superior iliac spine, the iliac crest, and the greater trochanter should be equal in height. The patellas should also be equal in height and face anteriorly. Examiner should identify genu valgus/varus. The medial malleoli should also be equal in height. The clinician should look for varus/valgus deformity of the forefoot and prone/supine position of the feet and note the foot arch.

Posterior inspection – Posterior observation is the most crucial aspect of inspection in patients with LBP. The symmetry of the head and shoulder height should be reexamined in this plane (Fig. 79.1). Scapular symmetry is assessed. The spine of the scapula is normally at the T3 level. The inferior angle of the scapula is at the level of T8. The clinician should assess the symmetry of the scapula at these levels. The distance of the inferior angle of the scapula from the spine is also noteworthy. With the inspection of the spine, the clinician should search for tissue asymmetry, signs of edema, or erythema. The spinal column should be evaluated for signs of scoliosis. Asymmetrical paraspinal fullness is also clinically significant and should be noted. The waistlines should be equal in height. Iliac crests should be symmetrical Gluteal folds, popliteal creases, and medial malleoli should also be symmetrical bilaterally. The Achilles tendons and the heels should be midline

Lateral inspection – With an examination of the patient in the coronal plane, alignment of the ear, the shoulder, and the peak of the iliac crest are assessed. The lumbar spine is generally in lordosis. An increased lumbar lordosis could be a sign of spondylolisthesis, weak hip extensors, or a hip flexor contracture. A flattened lumbar lordosis could be a sign of disc herniation or acute low back pain.

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses
  • Areas of Emphasis
    • Midline tenderness
    • Stepoffs
    • Sacroiliac joint

Range of Motion

  • Thoracic
    • Flexion: 80 from neutral
    • Extension: 30 from neutral
  • Lumbar
    • Flexion: 40-60 from neutral
    • Extension: 20-35 from neutral
    • Rotation: 45 from neutral
    • Lateral Flexion (side bending): 25 degrees from neutral

Strength

  • Motor examination
    • Should include examination of intrinsic back muscles and lower extremities
  • Back
    • Extension: Erector Spinae Muscles, Multifidus
    • Lateral Flexion (side bending): Erector Spinae Muscles, Quadratus Lumborum
    • Rotation: Multifidus
    • Flexion: Rectus Abdominis, Internal obliques, External Obliques
  • Hip
    • Hip Flexion (L2, L3): Iliopsoas
    • Hip Adduction (L2, L3): Gracilis, Obturator Externus, Adductor Brevis, Adductor Longus and Adductor Magnus
    • Hip Extension (L5): Gluteus Maximus, Biceps Femoris, Semitendinosus, Semimembranosus, Adductor Magnus
    • Hip Abduction (L5): Gluteus Medius, Gluteus Minimus, Tensor Fasciae Latae
  • Knee
    • Knee Extension (L3, L4): Rectus Femoris, Vastus Lateralis, Vastus Medius, Vastus Intermedius
    • Knee Flexion: Biceps Femoris, Semitendinosus, Semimembranosus, Gracilis, Sartorius, Gastrocnemius, Popliteus
  • Ankle
    • Dorsiflexion (L4, L5): Tibialis Anterior
    • Plantarflexion (S1): Gastrocnemius, Soleus, Peroneal Muscles
    • Eversion (S1): Peroneal Muscles
    • Inversion (L5): Tibialis Posterior
  • Foot
    • Toe Dorsiflexion (L5): Extensor Hallucis Longus, Extensor Digitorum Longus
    • Toe Plantarflexion (S2): Flexor Hallucis Longus, Flexor Digitorum Longus

Neurovascular

Dermatomes of the lower extremity[1]
  • Sensory Nerves
    • L1: Iliac crest, groin
    • L2, L3: Anterior and inner thigh
    • L4: Lateral thigh, anterior knee, medial leg
    • L5: Lateral leg, dorsal foot
    • S1: Posterior Leg
    • S2: Plantar foot
    • S3, S4: Perianal
  • Dermatomes (see image)
    • Knee: L3/L4
    • Achilles Tendon: S1/S2
  • Reflexes
    • Commonly Used
      • Patellar (L3, L4)
      • Achilles (S1, S2)
    • Uncommonly Used
      • Medial Hamstring (L5, S1)
      • Lateral Hamstring (S1, S2)
      • Posterior Tibial (L4, L5)
      • Cremasteric (L1, L2)
      • Anal wink/ bulbocavernous (S2)
  • Myotomes
    • L2: Hip Adduction, Hip Flexion
    • L3: Knee Extension, Hip Adduction, Hip Flexion
    • L4: Knee Extension, Dorsiflexion
    • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
    • S1 Foot Version, Plantarflexion
    • S2: Toe Plantar Flexion
    • S3: Bowel, bladder function
    • S4: Bowel, bladder function
  • Vascular
    • Femoral Artery
    • Popliteal Artery
    • Dorsalis Pedis Artery
    • Posterior Tibial Artery

Special Tests

  • Lumbar Radiculopathy (Sciatica)
    • Straight Leg Raise Test
    • Kemp Test
  • Herniated Nucleus Pulposus
    • Femoral Nerve Tension Test
    • Straight Leg Raise Test
    • Slump Test
  • Facet Joint Pain
    • Kemp Test
  • Spinal Stenosis
    • Kemp Test
    • Straight Leg Raise Test
  • Sacroiliac Joint Pain
    • Stork Test
    • Standing Flexion Test
    • One Legged Hyperextension
    • FABER Test
    • Posterior Shear Test
    • Resisted Abduction Test
    • Sacroiliac Distraction Test
    • Sacroiliac Compression Test
    • Gaenslens Test
    • Fortins Sign
    • Cranial Shear Test
    • Sacral Thrust Test
    • Active Straight Leg Raise Test
  • Spondylolysis
    • One Legged Hyperextension
  • Spondylolisthesis
    • One Legged Hyperextension
    • Provocative Walking Test
  • Ankylosing Spondylitis
    • Schobers Test
    • FABER Test
  • Sacral Stress Fracture
    • FABER Test
    • Flamingo Test
    • Gaenslens Test
    • Squish Test
  • Cauda Equina Syndrome
    • Bulbocavernous Reflex
  • Scoliosis
    • Adams Forward Bend Test
  • Upper Motor Neuron Lesion
    • Babinski Test
  • Spinal Cord Injury, Spinal Shock
    • Bulbocavernous Reflex

You Might Also Like This :

  1. Physical Examination of Forearm A forearm exercise test is a simple blood extraction in the forearm before and after the performance of a short exercise that is a very useful test in the diagnosis of certain disorders affecting the metabolic functions of the muscles. Inspection of the elbow and forearm, palpation, range of movement, pronation versus supination, testing motor power […]...
  2. Physical Examination of Shoulder The examiner must support the arm of the patient at the level of the elbow so that the upper extremity can be as much relaxed as possible. Then the examiner has to internally rotate the shoulder while at the same time perform a cross-body adduction of the arm. The test is positive if pain is […]...
  3. Physical Examination of  Wrist Physical examination of the wrist requires knowledge of wrist anatomy and pathology to make a diagnosis or narrow the differential diagnosis. Symptoms are provoked by palpation and signs are produced by manipulation. Negative findings elsewhere in the wrist are important. The final diagnosis may require diagnostic imaging. Follows the IP-PASS examination methodology Inspection Palpation Passive Range of Motion […]...
  4. Physical Examination of Elbow Physical examination of the elbow is a critical component in formulating an accurate diagnosis. Various special physical examinations have been described to improve the clinician’s ability to establish an accurate diagnosis. A comprehensive approach to the physical examination of the elbow, including special tests, may facilitate an improved diagnosis of elbow pathology. Inspection Palpation Passive […]...
  5. Physical Examination of Hand Examination of the hand is an essential piece of a hand surgeon’s skill set. This current concepts review presents a systematic process of performing a comprehensive physical examination of the hand including vascular, sensory, and motor assessments. The examination of the hand and nails can lead to a number of diagnoses. Some of these include […]...
  6. Neurological Examination of Spine Neurological Examination of spine is an essential skill to master that will benefit you throughout your medical and surgical career. This article describes the basic anatomy and surface markings of the spine that will aid your examination and also discusses diagnostic tests for common pathologies. The special tests in the spine examination allow clinicians to […]...
  7. Manual Test and Examination of Spine Manual Test and Examination of Spine is an essential skill to master that will benefit you throughout your medical and surgical career. This article describes the basic anatomy and surface markings of the spine that will aid your examination and also discusses diagnostic tests for common pathologies. The special tests in the spine examination allow […]...
  8. Examination of Spine – Types, Technique, Procedure Examination of spine is an essential skill to master that will benefit you throughout your medical and surgical career. This article describes the basic anatomy and surface markings of the spine that will aid your examination and also discusses diagnostic tests for common pathologies. The special tests in the spine examination allow clinicians to tailor […]...
  9. Tests of The Shoulder Joints and Physical Examination Tests of The Shoulder Joints and Physical Examination  (PETS) are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Despite more than 180 PETS described in the literature, evidence of their validity and usefulness in diagnosing the shoulder is questioned. The complex structure of the shoulder, with its variable pathological conditions of rotator […]...
  10. Lower Limb Examination – Technique, Procedure, Result The lower limb examination is a skill to elicit neurological signs, such as nerve problems that supply the legs and feet. Patients may present with a number of complaints including altered sensation, for example, pins and needles or numbness or loss of power of a limb. It may be intermittent such as multiple sclerosis or […]...
  11. Clinical Examination of Lower Limb Deformity Clinical Examination of Lower Limb Deformity/When a child is born, it has 10-15 degrees of physiological genu varum, 5-degree internal tibial torsion and external rotation contracture of the hip. It reaches the maximum by about 9-12 months. This usually gets corrected to neutral by the age of 18-24 months then the limb develops a valgus […]...
  12. Examination of Musculoskeletal System Examination of musculoskeletal system it is important to keep the concept of function in mind. Note any gross abnormalities of mechanical function beginning with the initial introduction to the patient. Continue to observe for such problems throughout the interview and the examination. On a screening examination of a patient who has no musculoskeletal complaints and […]...
  13. Examination of Knee Joint – Types, Technique, Procedure Examination of Knee Joint/The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint. The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee […]...
  14. Knee Joint Examination – Indications, Technique, Result Knee Joint Examination/The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint. The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint. […]...
  15. PLID Manual Test and Examination PLID Manual Test and Examination /Manual Test and Examination of Spine is an essential skill to master that will benefit you throughout your medical and surgical career. This article describes the basic anatomy and surface markings of the spine that will aid your examination and also discusses diagnostic tests for common pathologies. The special tests […]...

To Get Daily Health Newsletter

We don’t spam! Read our privacy policy for more info.

Terms and Conditions of Use
Privacy Policy
Cookie Policy
Editorial Policy
Advertising Policy
EU User Consent Policy
Correction Policy
Citation Policy
Ethics and Logical Policies
About Us
Contact Us
Newsletter
Career
Sitemap
Advertise with us
Editorial Board Members
Review Board Member
Team RxHarun
Web Developers Team
Guest Posts and Sponsored Posts
Request for Board Member
Women Writers
Download Mobile Apps
Follow us on Social Media
© 2012 - 2025; All rights reserved by authors. Powered by Mediarx International LTD, a subsidiary company of Rx Foundation.
RxHarun
Logo