A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin (Normal: intact; [abrasions/wounds, redness, hematomas (bruises), scars]) and mucous membranes.
- Gait pattern (fluid, limping).
- Body or joint posture (upright, bent, relieving posture) [postural disorders (pain-related relieving posture → avoidance scoliosis / pain scoliosis)].
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
- Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); soft tissue swelling; tenderness (localization! ); limited mobility (movement restrictions of the spine); “tapping signs” (testing the painfulness of the spinous processes, transverse processes, as well as the costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain? ; compression pain, from the front, side or saggital; hyper- or hypomobility?).
- Inspection (viewing).
- Functional testing (not only to determine range of motion, but also to elicit pain provocation: pain on coughing, sneezing, or pressing; pain on bending, hyperextension, or twisting).
- Lasègue test (synonyms: Lasègue sign* , Lazarević sign, or Lasègue-Lazarević sign) – describes possible stretching pain of the sciatic nerve and/or spinal nerve roots in the lumbar (lumbar spine) and sacral (sacrum) segments of the spinal cord; Procedure: the patient lies flat on the back when performing the Lasègue test. The extended leg is passively flexed (bent) at the hip joint by up to 70 degrees. If there is a pain response, flexion (bending) is not continued to the physiologically possible flexion. If there is significant pain in the leg up to an angle of about 45 degrees, shooting into the leg from the back and radiating below the knee, the test is considered positive. This is called a positive Lasègue sign.
- Reclination test (= Lasègue test in sitting): the patient sitting up straight lets the legs of his lower leg hang. The test is positive if, when the knee joint is extended, the upper body moves out backwards.
- Finger-to-floor distance (FBA): assessment of the overall mobility of the spine, hips and pelvis. For this purpose, the distance between the floor and the fingertips is measured at maximum forward flexion, while the knees should remain fully extended. Normal finding: FBA 0-10 cm
- Ott sign: Checking the mobility of the thoracic spine. For this purpose, a skin mark is applied to the standing patient above the spinous process of the seventh cervical vertebra (C7, HWK 7) and 30 cm further caudally (below). The changes in the measured distance during flexion (bending) are recorded. Normal findings: 3-4 cm.
- Schober sign: Checking the mobility of the lumbar spine. For this purpose, a skin mark is applied to the standing patient above the spinous process of S1 and 10 cm further cranial (above). At maximum flexion (after forward flexion), the skin marks normally diverge by 5 cm, at retroflexion (after backward flexion) the distance decreases by 1-2 cm.Psoas phenomenon: The examination of the psoas phenomenon is performed in the supine position. The patient actively raises the extended leg at the hip joint. Due to the rapid and sudden pressure on the distal thigh, the iliopsoas muscle is reflexively tensed with traction on the transverse processes of the lumbar spine. Patients with affections of the lumbar spine (eg, disc hernia / herniated disc, spondylitis / “vertebral inflammation”) or sacroiliac joints (ISG) now report pain.
- Amplification of pain due to:
- Hip flexion of the leg extended at the knee (Lasègue’s sign* ); additionally dorsiflexion of the foot (Bragard’s sign).
- Increased cervical spine flexion (Kernig’s sign).
- Hyperextension of the hip joint (Wassermann’s sign).
- Pressure on the intervertebral space below L 5 or S 1.
- Neurological examination – including verification of reflexes, motor and/or sensory deficits/muscle weakness or paralysis of specific muscles and/or sensory deficits in the affected dermatome/skin area autonomously supplied by the sensory fibers of a spinal nerve root/spinal cord root [Compression of spinal cord nerve roots:
- Cervicobrachial syndrome (synonym: shoulder-arm syndrome) – pain in the neck, shoulder girdle, and upper extremities. The cause is often the compression or irritation of spinal nerves of the cervical spine.
- Sciatica syndrome (lumboischialgia) – root irritation syndrome in which there is pain in the lumbar spine and in the supply area of the sciatic nerve.
- Cauda syndrome – it is a cross-sectional syndrome at the level of the cauda equina (extends from the lower end of the spinal cord (in adults, at about the level of the first lumbar vertebra) to the sacrum); this leads to damage to the nerve fibers below the conus medullaris, which is accompanied by flaccid paresis (paralysis) of the legs, often with urinary bladder and rectal dysfunction.
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
