Observation

  • Examination of any localised spinal disorder requires inspection of the entire spine.
  • Patient should therefore undress to their underwear.
  • Inspect for any obvious swellings or surgical scars.
  • Observe for scoliosis, kyphosis, loss of lumbar lordosis or hyperlordosis.
  • Inspect posture, shoulder levels, pelvic tilt and walking to assess abnormalities of gait.

Standing

Standing in front of patient

  • Active lumbar Range of Movement
Flexion 90°
Extension 30°
Lateral Flexion 30°
Rotation 30°

Seated

Standing in front of patient
DTR: Patella (L4), Hamstring (L5), Achilles (S1)
Motor: Quadriceps muscle test (L3, L4), Hip flexor muscle test (L1, L2, L3)
Orthopedics (seated)


Supine

Inspect feet, palpate temperature of feet, dorsal pedis & posterior tibial pulses, leg length, internal/external rotators, Anvil test
Neurologic Exam
Sensory: Light touch, sharp/dull or pin wheel Vibration (DIP, 3rd digit)
UMN: Babinski (L1 & above)
Motor: Tibialis anterior (L4, L5 – deep peroneal), Extensor hallucis longus (L4, L5, S1), Peroneus longus (L5, S1 – superficial peroneal), Flexor hallicus brevis (L5, S1)
Low Back/Pelvis Orthopedics
Leg Length Measurements
  • Greater trochanter to lateral malleolus
  • Pubic symphysis to medial malleolus
  • Umbilicus to medial malleolus
  • Leg girth measurements (thigh & calf)
Abdominal Exam
Observe, auscultate, percuss, palpate, inguinal nodes, sit up (abdominal strength & Beevor’s sign)

Side lying

Examiner stands near patient’s hip


Prone

  • Palpation – entire region
  • Check leg length
  • Palpate for calf tenderness
Orthopedics