mymrcgp

Physical Examination

Lumbar Spine

 

 

 

 

 

 

 

 

 

 

 

 

 

Common Examination Components:

(You are likely to be expected to examine the common components in each case)


Inspection: For bony deformity. Observe gait and movement as the patient moves to the couch. A gross assessment of power can be made by observing gait.


Palpation: Feel down the spine for bony tenderness.


Straight Leg Raise: For nerve root irritation (~80% sensitive and 40% specific increasing to 75% specific but 25% sensitive if the unaffected leg is positive.)
 

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Additional Examination Components:

(Examine an additional component If the specified indication is present)

 

Indication: ‘Red flags’ of neurological involvement in the history or found on examination

 

Components: Full lower limb neurological examination.

 

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Indication: Morning stiffness in the history

 

Components: Inspection for question mark posture of ankylosing spondylitis. Observe lumbar flexion & ideally measure distance (Schober's test).

 

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Indication: Altered sensation in the history

 

Components: Light touch sensation (thigh, below knee and foot). Trousers removed.

 

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Indication: Weakness in the history or on examination.

 

Components: Screen with an inspection of heel and toe walking. If weakness is present proceed to full lower limb neurological examination.

 

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Indication: ‘Red flags’ of neurological involvement in the history or found on examination

 

Components: Full lower limb neurological examination.

 

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What CSA Examiners and Trainers Expect - A Typical Scenario

(Study by N.Boeckx: Data from 300 GP Trainers and 16 CSA examiners)


Case Details: A 39 year old male presents with 2 weeks of low back pain. The cause is simple musculoskeletal low back pain. There are no alarming features in the history or on examination.  Choose the examinations you would expect from a safe GP in a competent 10 minute consultation.

Case Discussion: For simple low back pain the assessment can be brief. The examiners indicate the core components are inspection, gait assessment, palpation and straight leg raise testing.

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