Interactive Guide to Physical Examination
Before inspection of the back, ensure your patient is draped appropriately, but with the entire back exposed. Inspection is usually done with the patient in a standing position, with feet together and arms at the side. Inspect for scoliosis, birthmarks, patches of hair, or kyphosis.
Palpate over the thoracic, lumbar and sacral areas. First, evaluate for bony tenderness by palpating directly over the midline. Then, palpate the paravertebral areas bilaterally, evaluating for muscle tenderness or palpable spasm. If your patient is complaining of back pain, palpate directly over the sacroiliac joints, evaluating for sacroiliac joint inflammation.
The back moves through the coordinated efforts of the vertebrae, ligaments and major muscle groups. The back moves in forward flexion, rear flexion, rotation and lateral flexion. Remember that there is a wide range of normal, dependent on the patient's age, inherent flexibility and underlying medical conditions.
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Click on the video icon to view a demonstration of the back exam. |
