ANATOMY

5 regions, 33 bones
Regions
Cervical ( 7 vertebrae)
Thoracic ( 12 vertebrae)
Lumbar ( 5 vertebrae)
Sacral bone (5 fused =
Sacrum)
Coccygeal bone (4 fused
= coccyx)
 Vertebrae separated
by intervertebral
discs

Intervertebral discs
(anulus fibrosus +
nucleus pulposus)
Typical vertebra has :
Corpus vertebra
Arcus vertebra (lamina and pedicle)
Foramen vertebra
Processus spinosus (1)
Processus transversus (2)
Processus articularis superior (2)
Processus articularis superior(2)
Modified from Fig. 7.18
LOOK
 FEEL

STEPS ONE STEPS TWO

Tenderness Palpate the lateral

Tumor mass aspects of the vertebra
 STEPS THREE STEPS FOUR

Continue palpation into Examine the anterior

the supraclavicular fossa aspect of the neck
 MOVEMENT

STEPS ONE STEPS TWO STEPS THREE

Flexion Extension Using a spatula in the

Ask the patient to bend Ask the patient to till clenched teeth as a pointer.
the head forward the head backward Then ask the patient to flex
the head forward. Normal
range = 80
 STEPS FOUR STEPS FIVE STEPS SIX

Ask the patient to extend Lateral flexion Laterral flexion

the head. Normal range = Ask the patient to tilt For accurancy, using a
50 his head on to his right spatula as a pointer.
shoulder Normal range = 45
The total range in the
flexion and extension
planes should be
assessed.
Normal range = 130
 STEPS SEVEN STEPS EIGHT STEPS NINE

If lateral flexion cannot

Rotation Rotation
be carried out without
Ask to patient to look Again a spatula use a
forward flexion, this is
over the shoulder. pointer.
indicative of pathology
Normal range = 80
involving the
atlantoaxial and
atlanto-occipital joints.
SPECIAL TEST
 Position :
Patient stand

Examination :
Assess the thoracic
curvature from side

Note if the curve is regular

or if it appears to be
increased
 Position :
Bend forward

Examination :
Access the flow of movement in the
spine, and whether the curvature
increases

Note either the range of flexion in

the thoracic spine is small
 Position :
Stand upright and brace back the
shoulders to produce extension

Examination :
Assess the curvature of the
thoracic spine

Note the increase and

mobilization of the thoracic spine
 Position :
Patient standing and look
forward

Examination :
Check if there is a regular but
fixed kyphosis is found

Noted if there is fixed kyphosis

the causes may be Senile
kyphosis, Scheuermanns disease
and ankylosingspondylitis
 Position :
Standing and look forward

Examination :
Check for an angular kyphosis, with a
gibbus or prominent vertebral spine

Note if there is angular kyphosis with

gibbus or prominent vertebral spine the
commonest causes are fracture,
tuberculosis of the spine, or a congenital
vertebral abnormality
 Position :
Patient sitting and bend forward

Examination :
Palpate and look for tenderness
higher in the spine at the thoracal
spine

Note if there is tenderness, indicates

there are vertebral body infections
 Position :
Patient bend forward

Examination :
Lightly percuss the spine in an orderly
progression from the root of the neck to
the sacrum

Results :
Note that significant pain is a feature of
tuberculous and other infections, trauma
(especially fractures) and neoplasms
 Position :
Patient attempt to touch his toes

Examination :
Watch the spine closely for
smoothness of movement and any
areas of restriction

Note the importance of hip flexion

(A), which can account for apparent
motion in a rigid spine
 Position :
Patient bend forward

Examination :
Note the distance between the finger
and the ground

This is an indication of the summation

of thoracic, lumbar and hip movement,
it does not distinguish between them,
and is under voluntary control
 Position :
Patient flexes so that the fingertips
reach mid-tibia, or some other
appropriate level

Examination :
See the angle of range flexion. The
majority of normal patients can
reach the floor or within 7 cm from it

Actual maximum range flexion is

approximately 45 for thoracic
 Position :
Patient stand straight, sitting up, and
leaning forward on the examination
couch

Examination :
Flexion in the thoracic spine may be
measured with the upper point 30 cm
from the previous zero mark

Thoracic flexion is not great, and is

normally in the order of 3 cm. Note that
abdominal girth may increase after
osteoporotic fractures of the lumbar spine
 Schobers method : a 10
cm length of lumbar
spine is used as a base,
where a 15 cm length of
spine is employed.
Begin by positioning a
tape measure with the
10 cm mark level with
the dimples of Venus
(which mark the
posterior superior iliac
spines).
 Anchor the top of the
tape with a finger and
ask the patient to flex
as far forward as he
can.
 Flexion in the thoracic
spine may be
measured with the
upper point 30 cm
from the previous
zero mark.
 patient arches his
back, assisting him by
steadying the pelvis
and pulling back on
the shoulder
 measure the angle
formed between a line
drawn through T1, S1
and the vertical
 The patient should be
seated, and asked to
twist round to each
side. Rotation is
measured between the
plane of the shoulders
and the pelvis. The
normal maximum
range is 40 and is
almost entirely
thoracic
 Use a blunt object such
as the handle of a
tendon hammer to
stroke the skin in each
paraumbilical skin
quadrant.
Failure of the umbilicus
to twitch in the
direction of the
stimulated quadrant
suggests cor
compression on that
side at the appropriate
level
 Beevors sign
The patient places his hands
behind his head, flex his
knees, and sit up
See the movement of the
umbilicus to one side (and
up or down) suggests that
the abdominal muscles on
that side are unopposed i.e.
there is weakness on the
opposite side
 Check the patients
chest expansion at the
level of the 4thn
interspace
Less than 2.5 cm is
regarded as highly
suggestive of
ankylosing
spondylitis
 LOOK

Flatening
Reversal
A: Normal in women A: Cafe au lait spot Scoliosis
B: Spondylolisthesis B: Fat pad or hairy patch
C: Scaring
Look when patient sitting
Scoliosis in infant assess the Idiopathic scoliosis
rigidity of a curvature
Feel Tenderness

A: Between the spine of lumbar vertebrae and

lumbosacral junction

B: Over the lumbar muscles

Feel Tenderness

C: Sacroiliac joint
D: Higher in the spine
E: Vertebral body
Lightly percuss the spine in an orderly
progression from the root of the neck to the
sacrum.
Straight Leg Raising

1: Dorsoflexi the foot

2: Flexi knee
3: pressure with thumb in the
popliteal fossa
4: bowstring test
Flip test Ainds test Reverse Lasegue
 MOTORIC EXAMINATION

SCORING
Total paralysis 0
Palpable or visible 1
contraction
Active movement, 2
gravity eleminated
Active movement, 3
against gravity
Active movement, 4
against some resistance
Active movement, 5
against full resistance
Not testable NT