An example of a perfect spinal examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination based on the MSK "look-feel-move" guidance. Includes special tests.
- SOCRATES for pain FEEL
- Any neurological disturbance
- Red flags - Palpate spinous processes starting at occipital
- Social/yellow flags protrusion
- Palpate paraspinal muscles for tenderness
- Palpate sacroiliac joints (where dimples of
Venus are)
Red flags
- <16 or >50 with new pain
- Unexplained weight loss
- Unexplained fevers
- Past history of cancer MOVE
- Recent serious illness/infection - Flex and extend neck
- Previous long-standing steroid use - Turn head side to side
- HIV / AIDS - Touch ear to each shoulder
- End stage renal disease - Bend over to touch toes and lean back
- Osteoporosis or Paget’s disease - Hands on thighs and lean to the side
- Alcohol or drug abuse - Sit down, hands across chest, turn to each
- Widespread neurological deficits side
- Non-mechanical or thoracic pain
- Spinal deformity
- History of significant trauma/injury
- Fails to improve with treatment
SPECIAL TESTS
- Schober’s test – fingers on 2 lumbar spinous
Yellow flags processes, get patient to bend over and stand
- Attitudes back up. Fingers should separate and come
- Beliefs (and fears) back together for normal lumbar movement
- Compensation issues
- Adams forward bending test – assess for any
- Diagnosis
fixed spinal deformity
- Emotions (and coping strategies)
- Family - Straight leg raising test – lie down and raise
- Work leg. If any pain, lower leg and ask if better –
- Obstacles to recovery nerve impingement
LOOK
- Assess for normal thoracic kyphosis, lumbar Further investigations
lordosis, cervical lordosis
- Presence of spinal deformities – scoliosis, “For further investigations, I would like to perform a
kyphosis full neurological exam and take a full medical history”
- Skin changes, scars
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