Examination of spine

Reading File

Finding Sources

Searching Images

clinical examination of the spine anatomy diagram

This anatomical diagram illustrates the superficial and deep musculature of the posterior thoracic region, specifically focusing on the left rhomboid muscles. The illustration depicts the skeletal framework including the cervical and thoracic spine, the scapula, and the proximal humerus. Four key anatomical landmarks are identified with markers: the spinous process of the seventh cervical vertebra (C7), the spinous process of the fifth thoracic vertebra (T5), the medial angle (MA) of the scapula, and the inferior angle (IA) of the scapula. The rhomboid muscles are shown with their characteristic oblique fiber orientation, originating from the midline nuchal ligament and spinous processes (ranging from C7 to T5) and inserting along the medial border of the scapula. This diagram serves as a clinical reference for understanding musculoskeletal anatomy, surface landmarks for physical examination, and the localization of intramuscular targets for therapeutic interventions such as botulinum toxin injections or electromyography.

Reading File

Finding Sources

Reading File

Searching Images

straight leg raise test lumbar spine Lasegue

Reading File

Loading Image

I now have comprehensive content. Here is the complete structured overview of the examination of the spine:

Examination of the Spine

Source: Bailey and Love's Short Practice of Surgery, 28th Edition

The spinal column consists of 33 vertebrae with 23 intervertebral discs, supported by numerous ligaments and paraspinal muscles. Examination follows the standard orthopaedic sequence: Look - Feel - Move - Neurological - Special Tests, applied separately to the cervical, thoracic, and lumbar regions.

General Inspection (Standing Patient)

Coronal plane (front and back): A plumb line dropped from the spinous process of C7 should fall through the gluteal crease. The ear, shoulder and greater trochanter should lie in the same vertical plane.

Normal spinal alignment from behind - spinous processes marked

Sagittal plane (side view): Assess the four physiological curves - cervical lordosis (20-40°), thoracic kyphosis (20-45°), lumbar lordosis (40-60°), and sacral kyphosis.

Cervical Spine

Look

Expose shoulders, back muscles and scapulae
Look for muscle wasting and asymmetry of neck creases
Check shoulders are level and there is a normal cervical lordosis (20-40°)

Feel

Stand behind the patient, support the chin.

Soft tissues: Feel for spasm of the paraspinal muscles
Bone: Palpate the spinous processes for tenderness and alignment. C7 (vertebra prominens) and T1 are easily palpable at the base of the neck

Move

Motion occurs in three planes:

Movement	Normal Range	Method
Flexion	45°	Chin to chest; measure chin-sternum distance
Extension	55°	Patient looks up at ceiling
Rotation (R/L)	70°	Patient looks over each shoulder without moving chest
Lateral bending (R/L)	40°	Patient lays ear on ipsilateral shoulder

Neurological

Focus on C5 to T1 nerve roots, which supply the upper extremities. Assess sensation, tone, power, reflexes, proprioception and coordination.

Special Test - Spurling's Test

Used to detect cervical nerve root entrapment. The neck is extended and the head rotated toward the symptomatic side, then downward pressure is applied to the top of the head. Reproduction of radicular arm pain is a positive test.

Spurling's test - examiner applies downward pressure to patient's head

Thoracic Spine

Pathology commonly presents with pain and deformity. The thoracic spine is normally convex with a gentle kyphosis (20-45°).

Look

Ensure front and back from neck to gluteal cleft are visible.

Skin: Check for cafe-au-lait spots, hairy patches (may suggest occult neurology or bony pathology)
Front: Check for asymmetry of shoulder and ribcage suggesting scoliosis
Back: Check for difference in iliac crest height (pelvic tilt); look for coronal plane deformity (scoliosis); a rib hump suggests structural scoliosis
Side: Assess for increased kyphosis (sagittal plane deformity)

Feel

Palpate with one hand supporting the patient's pelvis.

Move

Forward bending test (Adam's test): Ask the patient to bend forwards to touch their toes:

Forward bending test showing rib hump in scoliosis

Structural scoliosis: Rib hump increases as patient bends forwards (bulges posteriorly on thoracic convex side) - diagnostic of idiopathic thoracic scoliosis with rotatory deformity
Functional scoliosis: Spine straightens on forward bending, no rib hump - secondary to abnormal leg lengths or lumbar muscle spasm

Lateral bending: Assesses flexibility of scoliosis; radiographs can be taken in this position.

Lumbar Spine

Always examine the pelvis, hips, lower limbs, gait, and peripheral vascular system alongside the lumbar region. Always consider referred pain - nerve irritation in the lumbar spine can mimic lower limb problems.

Look

Back: Check skin at base of spine for hairy tufts and dimples (underlying spina bifida); unilateral prominence of spinal muscles suggests muscle spasm
Side: The lumbar lordosis (normal 40-60°) should have a smooth concavity; loss of lordosis suggests muscle spasm

Feel

Feel for any 'step-off' in the spinous processes - this may indicate forward slippage of one vertebra on another (spondylolisthesis).

Move

Movement	Normal Range	Method
Forward flexion	40-60°	Schober's test: thumb on T12/L1 junction, index on lumbosacral junction - measure separation as patient bends; also note finger-floor distance
Lateral bending	-	Slide hand down outer thigh; compare each side
Rotation	3-18°	Hold pelvis still; ask patient to twist and look over shoulder

Neurological

Focus on L1 to S1 nerve roots. Assess sensation, tone, power, reflexes (particularly knee jerk L3/4, ankle jerk S1), proprioception and coordination.

Special Tests

Lasègue's Straight Leg Raise (SLR) Test - increases tension along the sciatic nerve (L5 and S1 roots):

Patient supine - elevate the leg with the knee bent to check pain-free hip movement
Straighten the knee and note the angle at which hamstrings allow hip to flex
Lower the hip until tension is removed from hamstrings, then firmly dorsiflex the ankle
Positive test: pain running down the leg (sciatica) on ankle dorsiflexion

Contralateral stretch test: Elevate the asymptomatic leg; if pain is reproduced in the other (symptomatic) leg, the test is positive (indicates significant nerve root compression, e.g. large disc prolapse).

Summary: Spine Examination at a Glance

Step	Cervical	Thoracic	Lumbar
Look	Lordosis, wasting, alignment	Scoliosis, rib hump, kyphosis, skin marks	Lordosis, hairy tufts, dimples, muscle prominence
Feel	Paraspinal spasm, spinous processes	Palpate with pelvis supported	Step-off deformity
Move	Flex/Ext (45°/55°), Lat bend (40°), Rotation (70°)	Forward bending test, lateral bending	Flex (40-60°), Lat bend, Rotation (3-18°)
Neuro	C5-T1 roots (upper limb)	Thoracic roots (trunk)	L1-S1 roots (lower limb)
Special tests	Spurling's test	Forward bending (Adam's) test	SLR (Lasègue's), Contralateral stretch

Bailey and Love's Short Practice of Surgery, 28th Ed., Chapter 35, pp. 497-500

This is a shared conversation. Sign in to Orris to start your own chat.