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Examination of the spine video


Look initially from behind the patient for any obvious muscle wasting, asymmetry or scoliosis of the spine. Look from the side for normal: cervical lordosis thoracic kyphosis and lumbar lordosis.


Feel down the spinal processes, over the sacroiliac joints and palpate the paraspinal muscles for any obvious tenderness.


Flexion and extension should be assessed. Two or three fingers placed over the lumbar spine will move apart and then together during flexion and extension. Lateral flexion is assessed by asking the patient to run each hand down the ouside of the adjacent leg in turn. Cervical movements include lateral flexion, rotation and full flexion and extension.

With the patient sitting on the couch to fix their pelvis, and their arms crossed in front of them, thoracic rotation is assessed.

With the patient lying as flat as possible on the couch, straight leg raising is performed. Dorsiflexion of the foot may exacerbate the pain caused by nerve root entrapment or irritation such as a prolapsed intervertebral disc. A brief neurovascular examination including the assessment of limb reflexes, dorsiflexion of the big toe, and assessment of peripheral pulses should be made. If there has been any indication of abnormality from the history, a full neurological and vascular examination including sensation, tone and power should also be performed.

Student handbook

Download 'Clinical assessment of the musculoskeletal system: a guide for medical students and healthcare professionals'

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