Clinical examination notes of back/spine especially based on TU course of MBBS in Nepal.I hope many students will be helped with this notes.

1. Back/Spine Examination
Prepared by:
Sunil Baniya
Student, NAIHS-COM,
sanobharyang, ktm, Nepal
1Knee Examination/ Sunil Baniya

2. • Adequate exposure is essential; patients must strip to their underclothes
• Examination in standing, sittting and supine examination
1. LOOK
– Gait
Front
– Posture
– Forward bending
– Lateral list

3. – Asymmetry of chest, pelvis
– Scars, sinus
– Leg shortening
– Side
– Kyphosis
– Lordosis
– Scars, sinus

4. Back
- Tufts of hair
- Café au laits spots
- Paraspinal muscle spasm
- Scars
- Muscle wasting
- scoliosis

5. 2. FEEL
a. Temperature
b. Tenderness:
– Elicit spine tenderness by 3 methods
i) Pressure over the interspinous area
ii) Twisting or pressure over the paraspinous part (facet joint) =
Spinous Rock
iii) Thumping over vertebral column

6. 3. MOVE
o Forward flexion:
- Touching toes
- Majority touches the ground
- Touching mid tibia, 7 cm above the floor
o Extension: normally 30°
o Lateral flexion: try to touch each side of leg (Average = 30°)
o Rotation: maximum 40° (first fix pelvis then only ask for rotation)

7. 4. MEASUREMENT:
o To measure the lumbar excursion
o Take any two bony points over the lumbar region 10 cm apart while
standing upright
o Measure the distance between that points when patient is asked to bend
forward fully
o The distance must be increased by at least 5 cm (i.e; lumbar excursion
= 5cm)
o If less than 3 cm, substantial pathology like ankylosing spondylitis

8. SPECIAL TESTS:
1. SLRT (Straight Leg Raising Test)/Sciatic stretch test/ Dural tension test
2. Well Leg Raise Test or Cross SLRT test
3. Bragard test
4. Lassegue’s test
5. Bowstring’s test
6. Patric test ( Faber sign) = for sacroiliac pathology

9. SLRT/ Sciatic Stretch Test/ Dural Tension Test:
Method:
o 1st do as active by patient himself
o Confirm by passive method
o Finding: test is +ve, if pain occurs between 30° – 70° of elevation
o Back pain = central disc prolapse
o Pain that radiates back to below knee, not just the thigh or back
pain = lateral protrusion

10. Well Leg Raising Test/ Cross SLRT/Contralateral SLRT:
Method:
o Definitive test for disc disease
o Perform SLRT on normal leg
o Finding: Cross over sciatic pain & parasthesia on affected leg =
large prolapse close to midline

11. Bragard Test:
Method:
o Sciatic nerve stretch test
o If SLRT +ve, leg lowered about
10° from the point of sciatic pain
o Foot is dorsiflexed to reproduce
the same pain

12. Lasegue’s Test:
Method:
o Patient supine
o Thigh bent at 90° & knee bent at 90°
o Gradually extend the knee keeping hip flexed
o Thigh pain radiates down the leg = +ve

13. Bowstring’s Test:
Method:
o SLRT +ve
o Slight flex the knee just to
relieve pain
o Then firmly press behind
lateral hamstrings to tighten
the common peroneal nerve
o Radiating pain &
parasthesia reappears
o Finding: +ve Bowstring’s
sign i.e; nerve root irritation

14. 5.NEUROLOGICAL EXAMINATION:
L4 nerve:
o Motor : grading of dorsiflexion
o Sensory: medial aspect of the leg
o Reflex: knee (normal/brisk/sluggish/absent)
L5 nerve:
o Motor: EHL (Extensor Hallucis Longus),
plantiflexion, dorsiflexion of toe
o Sensory : Anterolateral part of leg and dorsum of
foot
o Reflex: ankle jerk
S1 nerve:
o Motor: plantar
flexion
o Sensory: Lateral
aspect of the sole
o Reflex: ankle
reflex

15. THANK YOU
15Knee Examination/ Sunil Baniya