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Waleed Awwad, MD, FRCSC

Learn the essential aspects of conducting a thorough physical examination of the spinal column, including inspection, palpation, range of motion assessment, neurologic manipulations, and special tests. This guide covers surface anatomy, alignment, gait abnormalities, sensory and motor examinations, reflexes, nerve tension tests, and more.

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Waleed Awwad, MD, FRCSC

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  1. Spine Physical Exam Waleed Awwad, MD, FRCSC

  2. Anatomy • Spinal Column

  3. Anatomy • Spinal Column

  4. Anatomy • Spinal Column

  5. Anatomy • Spinal Column

  6. Anatomy • Spinal Column

  7. Anatomy • Spinal Column

  8. Anatomy • Spinal Column

  9. Anatomy • Spinal Column

  10. Anatomy • Spinal Cord

  11. Anatomy • Spinal Cord

  12. Physical exam • Inspection. • Gait. • Palpation. • Range of motion. • Manipulation ( Neurologic Ex ). • Special tests.

  13. inspection • Surface anatomy and alignment • Coronal and sagittal alignment • Shoulder level • Thoracic hump • Waist symmetry • Pelvic obliquity • Skin lesions

  14. gait • Shuffling and slap foot gait • Broad-based gait • Antalgic gait

  15. palpation • Spinous process for tenderness or step • Musculature for spasm

  16. Range of Motion • Cervical spine • Thoracic spine Flexion and extension, Modified Schober test and chest expansion. • Lumber spine

  17. Neurologic • Muscle Test • Sensory exam light touch, Sharp dull discrimination, Vibration sense, Proprioception and two-point discrimination • Reflexes

  18. Neurologic Sensory Levels C5 over deltoid C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region

  19. Neurologic • Myotomes C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor ( lower thoracic nerve root –Beever sign ) L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors

  20. Neurologic • Reflexes Biceps reflex, Brachioradialis reflex, triceps reflex Abdominal reflexes Knee, ankle, planter reflex

  21. Special test • Nerve Tension Tests Upper limb tension test Lower limb tension test Strait-leg raising test (SLRT) Crossed SLRT Lasegue’s test Femoral nerve stretch test

  22. Special test • Axial compression test • Spurling’s test • Nonorganic signs of Waddell Simulation test (axial compression, rotation simulation) Non anatomic tendrness Distraction sign Regional sensory or motor disturbance Overreaction

  23. Thank you

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