Back Exam | posttakeround

Back Exam

This was my standard back exam, acknowledging the vast majority of time it is going to be ankylosing spondylitis, and hence the proceed is mainly targeted towards features of this (such as looking for AR).

Expose - ask to shirt off
Inspect whilst standing
1. Make a big deal from standing from all sides
2. If AS, then look for question mark sign
Go straight into measurements - ask them to walk to the wall
Measure occiput to wall distance or tragus to wall distance
Lateral flexion without lifting back from wall
1. Measure tip of finger to floor
2. Then re-measure after they have reached down as far as possible
Ask them to take one big step forward
Do modified Schobers (<5cm is abnormal)
CAN COMMENT ON EXTENSION, BUT DON’T HAVE TO DO IT
Then sit them on edge of bed with legs hanging over side
Hands on hip. Ask to rotate as far to left possible, and then to right
Then measure thoracic chest expansion
1. Talley's says tape measure around nipple line or 4th intercostal space (<4cm is restricted), however I just do chest expansion like we do in the Respiratory exam
Then test cervical movements
1. Extension, flexion
2. Without lifting shoulders, touch ear to shoulders (45 degrees)
3. Rotation - ‘pretend you’re back out your car’ - “compensatory shifting of the lumbar spine”
Then proceed to other joints/features
Quickly examine hands
Look at face and hairline, show elbows look for psoriatic plaques, then look at knees, then look at feet
Examine feet
1. Note, in this, given minimal time, this mainly involved inspection (nail changes, deformity, dactylitis). You can refer to Talley's for a dedicated foot exam (if you are unlucky enough to get this), but it resolves around the same structure of look, feel, move etc.
2. Feel achilles tendon for Enthesitis (tendon insertion), tendonitis, push on heel for plantar fasciitis
LISTEN TO THE LUNGS
Then as they are on the bench, swing them around to 45 degrees and do cardiac disease
1. Palpation, listen etc. - do dynamic movement for AR