Look for antalgic gait or foot drop
Dimples, pigmentation, or abnormal hair may indicate Spina Bifida Occulta
Check buttock folds for asymmetry
Assess cervical lordosis, thoracic kyphosis, lumbar lordosis
Look for lateral spine curvature during forward flexion
Use back of hands, compare sides
Key landmarks: C7 (vertebra prominens), T3 (base of scapular spine), T7 (inferior angle of scapula), L4 (supracristal plane)
Check for step deformities or tenderness
Normal range 75-90°. Pain <30° suggests facet joint pathology, >30° with leg referral suggests nerve root compression/disc issues
Normal range 20-30°. Lateral pain may indicate facet joint pathology (older) or pars stress (adolescent)
Normal range 30°
Normal range 60°
Mark PSIS level, 5cm below and 10cm above. Should increase from 15cm to >20cm with forward flexion. <5cm increase indicates reduced lumbar flexion
To unmask a suspected loss of spinal extension, have the patient stand with their back against a wall, ensuring that their heels, buttocks, shoulders, and occiput all make contact with the wall surface. This position helps identify any abnormal loss of extension in the spine.
Pain suggests posterior element pathology on same side
To screen for a disc lesion or dural tethering, have the patient sit on a couch in a relaxed posture with their legs hanging off the side. The patient should slump forward, placing their chin on their chest. Then, straighten one leg and check for any reproduction of pain radiating into the posterior thigh and leg. If pain occurs, deflex the neck to confirm whether the pain is of spinal origin. Repeat the procedure on the opposite side.
Checks for lumbosacral root tension. Look for pain in posterior thigh, buttock, and lower back
Checks for lumbar root tension. Positive if pain felt in anterior thigh and back
Facet joints ~2cm from midline, costotransverse junctions ~4cm from midline in thoracic spine
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