Expansion
Inspection, movement, palpation and the neurological screen
Expansion
Look, standing, from behind and from the side
- From behind: scoliosis, shoulder and pelvic asymmetry, scars, café au lait spots, hairy patches
- From the side: cervical lordosis, thoracic kyphosis, lumbar lordosis, and the loss of lumbar lordosis characteristic of ankylosing spondylitis
- Gait
Move
- Cervical: flexion (chin to chest), extension, lateral flexion (ear to shoulder), rotation
- Thoracic: rotation with the arms crossed, seated to fix the pelvis; and chest expansion, normally over 5 cm and reduced in ankylosing spondylitis
- Lumbar: flexion, extension, lateral flexion (hand down the side of the leg)
Schober’s test: mark the dimples of Venus, then 5 cm below and 10 cm above. On full flexion the distance should increase from 15 cm to more than 20 cm. Less than 5 cm of increase indicates restricted lumbar flexion.
Feel: spinous processes and interspinous ligaments for step and tenderness, paraspinal muscles for spasm, sacroiliac joints.
Special tests
- Straight leg raise: pain radiating below the knee between 30 and 70 degrees suggests L5 or S1 root irritation. Sciatic stretch, and reproduction on dorsiflexion, supports it
- Femoral stretch test, prone, for L2 to L4
- Sacroiliac compression and distraction
Complete with a lower limb neurological examination, the abdomen and peripheral pulses, and, where indicated, digital rectal examination and perianal sensation for cauda equina.