Orthopaedic PE
Cervical Spine Examination
1LookSit / stand & inspect
From behind
Normal
Scoliosis
Muscle wasting
Torticollis
Low hairline
Café-au-lait spots
Scar / previous surgery
From the side
Normal cervical lordosis
Reduced cervical lordosis
Cervical kyphosis
Thoracic kyphosis
Reduced lumbar lordosis
From the front
Normal
Asymmetry
Supraclavicular fullness
Cervical rib visible
2FeelPalpation
Non-tender
Midline tenderness
Paraspinal tenderness
Trapezius tenderness
Occipital tenderness
Supraclavicular tenderness
Cervical rib palpable
Step-off deformity
3MoveRange of motion
Full ROM
↓ Flex
↓ Ext
↓ L lat flex
↓ R lat flex
↓ L rot
↓ R rot
Goniometry drag to record degrees
4Gait and balanceWalk & Romberg's
Normal gait
Spastic / myelopathic
Broad-based
Scissor gait
Antalgic gait
Tandem impaired
Romberg's +ve
5Neurological examination
Upper limb — tone
Normal tone (UL)
Increased tone (UL)
Reduced tone (UL)
Spasticity
Upper limb — sensation middle finger = C7
Upper limb — myotomes MRC grade · ASIA
Upper limb — reflexes
Myelopathy tests upper motor neurone
Lower limb — myelopathy screen
Normal tone (LL)
Increased tone (LL)
Clonus +ve
Normal power (LL)
Weakness (LL)
Intact sensation (LL)
Sensory level
Provocation tests
L'hermitte's
Distraction test
PR if indicated
Rectal exam
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