Osteoporosis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height [reduction in height]; further:
    • Inspection (viewing).
      • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
      • Gait pattern (fluid, limping) [gait insecurity due to faulty statics and shift in center of gravity].
      • Body or joint posture (erect, flexed, relieved posture) [The following symptoms present themselves:
        • Fir tree phenomenon (= cross folds of the skin are formed on the back). This is due to the shortening of the spine, whereby the trunk muscles and the overlying soft tissues, including skin, become relatively too long.
        • The extremities appear relatively too long compared to the trunk (apparently too long arms). The rib arches approach the iliac crests. Because of the convergence of the origin and insertion of the abdominal muscles and the increased lordosis (forward (ventral) convex curvature of the spine) of the lumbar spine, the abdomen bulges forward. The abdominal muscles are no longer able to perform their supporting work even when tensed, and the pelvis tilts forward. The already developing hyperlordosis of the lumbar spine (LS) is thereby reinforced.
        • With increasing thoracic kyphosis (widow’s hump) must be taken, in order to be able to look straight ahead, a hyperlordosis of the cervical spine (cervical spine) and bending posture of the knee joints].
      • Malpositions (deformities, contractures, shortenings).
      • Muscle atrophies (side comparison!, if necessary circumference measurements).
    • Palpation (palpation) of the vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); soft tissue swelling; tenderness (localization! ); limited mobility (spinal motion restrictions); “tapping signs” (test for painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain?; compression pain, anterior, lateral, or saggital); hyper- or hypomobility? [Pain: osteoporotic fracture pain is very severe and lasts for circa four to six weeks, until consolidation of the fracture (if the fractures do not heal, even longer); typically, there is a vibration sensitivity of the spine (tapping sensitivity) and pain that radiates in a belt-like manner to the ventral (front); compression pain].
    • Other examinations:
      • Spinal mobility
      • Lateral tilt test
      • Measurement of the rib arch iliac crest distance.
      • Measurements of the occiput-wall distance
      • Measurement of arm span
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.