Orthopaedic PE
Lumbar Spine Examination
1LookStand & inspect
From behind
Normal alignment
Scoliosis
Lateral list
Muscle spasm
Café-au-lait spots
Spinal dysraphism stigmata
Scar / previous surgery
From the side
Normal lumbar lordosis
Reduced lumbar lordosis
Increased lumbar lordosis
Thoracic kyphosis
Normal cervical lordosis
From the front
Normal
Lateral list
Pelvic tilt
2FeelPalpation
Non-tender
Midline tenderness
Paraspinal tenderness
SIJ tenderness (left)
SIJ tenderness (right)
Sciatic notch tenderness
Step-off deformity
3MoveRange of motion
Full ROM
↓ Flex
↓ Ext
↓ L lat flex
↓ R lat flex
↓ Rotation
Goniometry drag to record degrees
Schober's test
Lumbar expansion
cm expansion · normal ≥ 5 cm
4Screen testsNerve roots
Squat & stand (L3)
Heel walk (L4)
Trendelenburg (L5)
Tiptoe (S1)
5GaitWalk
Normal gait
Antalgic gait
High-stepping / foot drop
Trendelenburg gait
Wide-based gait
Spastic gait
6Neurological examination
Tone passive hip roll
Normal tone
Increased tone
Clonus +ve
Hip roll symmetrical
Hip roll restricted (L)
Hip roll restricted (R)
Sensation around knee = L3
Myotomes MRC grade · ASIA
Reflexes
Provocation tests
SLR angle L / R
degrees
Cross sciatic
PR if indicated
Rectal exam
Saddle sensation intact
Saddle anaesthesia
Vol. contraction present
Vol. contraction absent
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