Examination of the ThoracoLumbar Spine
Look
Clues
- walking / mobility aids
- external appliances
- lumbar brace
- AFO
Standing
- Front
- General Manifestations of systemic disease
- Body habitus
- Syndromes (Marfan’s, NF)
- pectus excavatum/carinatum (Marfan’s)
- Skin
- Face
- Wasting
- quadriceps
- Side
- Lordosis
- Normal 60°
- (Hyperlordosis / swayback )
- usually flexible def
- associated with FFD hips
- look for prominence of buttocks
- Reversible
- associated. pain & muscle spasm
- spondylolysis, ank.spond
- Lumbar Flatback syndrome
- rigid lumbar spine & no lordosis
- Compression anterior wedge fractures, degeneration
- Gibbus
- sharp, angular kyphotic deformity. TB, tumours, other infections, fractures
- Kyphosis / Lordosis (↑ or flat back)
- Back
- Skin
- Scars, sinuses
- Cutaneous manifestations of Spina Bifida
- Hairy patch, naevi, café-au-lait, lipomas
- Spinal coronal alignment
- Normal
- Scoliosis
- Helical abnormality
- Structural or secondary
- Balanced?
- Flexible
- List
- abrupt planar shift of spine above certain point (pain, herniated disc, muscle spasm)
- Symmetry
- Shoulders
- Scapular
- Pelvis
- Legs
- Wasting
- Buttocks, thighs, calves
- Symmetry of stance
Feel
- Spinous processes
- tenderness, steps
- Step off deformity
- Spondylolisthesis
- Especially L5 S1
- (50% step before step off is positive)
- Gibbus
- sharp, angular kyphotic deformity
- Paravertebral muscle spasm
- Trigger points
- tender nodules within paraspinous muscles. Reaction to painful stimulus or fibromyalgia
- Landmarks
- iliac crest- L4/L5 interspace
- Pelvic obliquity
Move
- LLD & block
- Trendelenburg
- Differentiates
- Pin
- L5 root lesion vs sciatic nerve lesion
- Forward Flexion (80-90˚)
- Standing with feet together & knees straight
- fingertips from floor
- Comment on
- 1. Irritability
- 2. Amount (fingertips in relation to front of legs)
- 3. Spinal excursion – Modified Schrober’s test
- (S1 – L5) 10cm above + 5cm below lumbosacral junction
- Distance should ↑ 6cm
- Abn: Ankylosing Spondylitis
- 4. Unrolling of the lumbar spine
- look for normal flattening of lumbar lordosis
- There is normal thoracolumbar movement
- Lost in ank spond
- limited in disc herniation
- 5. Thomas Forward Bending Test
- Rib hump
- Extension 20°
- from flexed position
- if not full, perform Wall Test
- Comment on
- irritable
- difficulty (hands on thighs)
- "There is a normal extension range"
- extension narrows canal
- spinal stenosis
- post traumatic deformities
- tumours
- painful posterior elements
- Lateral flexion 20°
- Lateral Bending (stabilize pelvis)
- normal 20-30º
- look for
- asymmetry
- irritability
- herniated sacs avoid bending to effected side
- Thoracic Rotation