Physical Examination
Spine and Extremities
Liaoning Medical University
Affiliated First Hospital
He Xin
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一、Spine
Diseases of spine often present with pain、
abnormalities of posture or configuration,
and limited activity
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Contents of examination of Spine
1、Curvature of Spine
2、 Activity of spine
3、 Pressing and Percussive Pain
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1、Curvature of Spine
Physiologic curvature
Four curvatures including cervical, thoracic,
lumbar and sacral vertebrate can be seen in
human when observe laterally,
characterized as shape “S”. Lateral
curvature may not be inspected in normal
people
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Anatomy of spine
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Pathological deformity
Kyphosis or gibbus
---Rachitis
---Tuberculosis
---Rheumatoid spondylitis
---Osseous retrogrde degeneration
---Others: trauma, dysplasia or spondylous
steochondritis
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Scoliosis
---The posture scoliosis common causes are
(a) false posture in maturity of child hood
(b) the unilateral lower extremity is much shorter
(c) prolapse of intervertebral cartilages
(d) poliomyelitic sequelae
---Organic scoliosis
The character of this condition is that it can not
be corrected by changing posture
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2、 Activity of spine
Normal activity
The normal active ranges of cervical and
lumbar vertebrae are as follows:
antexion
extension
Left and
Right Lateral
rotation
curvature
Cervical vertebrae
45°
45°
45°, ana
60°
Lumbar vertebrae
45°
35°
30°, ana
45°
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Limited activity
The common causes of limited activity of
cervical vertebrae
--- cervicomuscular strain
--- proliferative arthritis
--- tuberculosis or cancer
--- fracture or trauma of cervical vertebrae
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Limited activity
The common causes of limited activity of
lumbar vertebrae
--- strain of lumbar muscles
--- proliferative arthritis
--- tuberculosis or cancer
--- fracture or trauma of lumbar vertebrae
--- prolapse of intervertebral cartilage.
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3、 Pressing and Percussive Pain
Pressing pain
The common causes are tuberculosis of
spine, prolapse of intervertebral
cartilages, fracture, or trauma
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3、 Pressing and Percussive Pain
Percussive pain
The inspecting methods include direct and
indirect percussion. Positive of this sign
will indicate some diseases of spine as
tuberculosis, fracture, or prolapse of
intervertebral cartilages. The percussive
pain site usually hints the disease site.
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二、Extremities
Examination of the extremities is conducted
primarily by inspection and palpation. The two
methods will be considered together. Normally any
two comparable extremities are nearly symmetric.
Asymmetry, when present, may be attributed to
atrophy, congenital defects, or traumatic deformities.
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Contents of examination of Extremities
1、Paramorphia
2、Unusual Movements and
Abnormalities
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1、Paramorphia
koilonychia, Acropachy, acromegaly,
Genua varus and valgus, Pes varus and pes
valgus, Fracture and abarticulation Pes
planus or flat foot, Muscle atrophy,
Varicose veins of lower extremities, Edema
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2、Unusual Movements and
Abnormalities
unusual movements of the upper and
lower extremities are in most instances
manifest by disturbances of gait, movement
tremor, rest tremor, liver flap, and so on
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三、Articulus
Normally all the articuli will remain their
special conformation and function well unless
they are disease. Any joint deformity should be
described with regard to its location, general
appearance, range of movement, swelling,
redness, warmth, tenderness, and crepitation.
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1、Paramorphia
---wrist joints
tendovaginal synovitis , Ganglion cyst ,
Tendovaginal fibrolipoma , Others
---phalangeal joints
fusiform joints, Claw hand , Others
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2、Articulations genu
Asymmetry of the articulations genu
with redness, swelling, fever, tenderness,
and unusual movements are often due to
inflammation by acute rheumatic
arthritis. Effusion of cavum articulare
can be diagnosed by palpation
characteristically as floating patella
phenomenon.
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Floating patella phenomenon
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3、Others
Rigidity, hypertrophia, or deformity of joints,
and nodular tophi due to irregular bony
erosions caused by hyperuricaemia are present
in gout. The most commonly involved joints
are the great toe, ankle, tarsus, and knee. In
40% it involves more than one joint.
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4、Movement Function
Movement range and tenderness should
be detected during the active and passive
movement of each joint.
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