28. The spine

Examination of the spine consists of examining the cervical, thoracic and lumbar spinal column. Make sure that the patient is sufficiently unclothed, so that the connections between the various parts can be observed. The examination should be carried out in the following order: inspection (with superficial palpation), movement assessment, clinical palpation and the specific tests. It is important to observe the patient for movement limitations and pain throughout the tests, to stabilise the trunk and use the correct hand positions for the various joints being examined. Any abnormalities found from physical examination should always be interpreted in light of the patient’s context (from history-taking). As an isolated abnormal test finding will often have little scientific value. Physical examination findings will more reliable if those from history-taking, inspection, movement assessment, palpation and the specific test combined are consistent with the diagnosis. Common abnormalities and problems that can be found include scoliosis, thoracic kyphosis, neck and back problems (e.g. lumbago and non-specific myalgia), and degenerative disorders, such as spondylosis, spondylarthrosis deformans and facet joint arthrosis.