Examination

The cervical spine can be examined with the patient seated. You should inspect the cervical spine from the front, back, and sides for deformity and unusual posture. Test range of motion of the cervical spine. Palpate the paravertebral muscles for tenderness and spasm.

The thoracolumbar spine is examined with the patient standing in front of you. Inspect the spine for deformity or swelling. Inspect the spine from the side for abnormal curvature. Test ranges of motion. Palpate the paravertebral muscles for tenderness. Percuss each spinous process for tenderness.

The ranges of motion tested in the spine are forward flexion, extension, lateral flexion, and rotation.

The presence of a cervical rib may cause coldness, discoloration, and trophic changes as a result of ischemia to an upper extremity. To test for a cervical rib, palpate the radial pulse. Move the arm through its range of motion. Obliteration of the pulse by this maneuver is suggestive of the presence of a cervical rib. Ask the patient to turn the head toward the affected side and take a deep breath while you are palpating the radial pulse on the same side. Obliteration of the pulse by this maneuver is also suggestive of a cervical rib. Often, auscultation over the subclavian artery reveals a bruit suggestive of mechanical obstruction by a cervical rib. Repeat any of these tests on the opposite side. Cervical ribs are rarely bilateral.

Pain from entrapment of the sciatic nerve is called sciatica. Patients with sciatica describe pain, burning sensation, or aching in the buttocks radiating down the posterior thigh to the posterolateral aspect of the calf. Pain is worsened by sneezing, laughing, or straining at stool. One of the tests for sciatica is the straight leg raising test. The patient is asked to lie supine while the examiner flexes the extended leg to the trunk at the hip. The presence of pain is a positive test result. The patient is asked to plantarflex and dorsiflex the foot. This stretches the sciatic nerve even more. If sciatica is present, this test reproduces pain in the leg. The test is illustrated in Figure 20-40.

Another test for sciatica is the sitting knee extension test. The patient sits off the side of the bed and flexes the neck, placing the chin on the chest. The examiner fixes the thigh on the bed with one hand while the other hand extends the leg. If sciatica is present, pain is reproduced as the leg is extended. This test is demonstrated in Figure 20-41.

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