In this world of wide spectrum diagnostic tools and dazzling information technology, medical practice has often relegated physical examination to the background. In spine care, however, along with radiological procedures, precise physical examination continues to be one of the main diagnostic pillars in forming the most comprehensive clinical picture of a patient’s condition. We would emphasize the fact that taking a good patient history - asking questions of the Patient regarding the nature of the problem, its beginning and provoking factors, other accompanying diseases, etc. - may often be of great diagnostic value and may, in and of itself, be an important indicator of the clinical picture. There has not been, to date, an established universal method of examination with each school and practice following various methods of examination. The most important factors in spine care in forming a medical opinion is establishing the relationship between the actual complaints and symptoms and the functional and morphological condition of the spine.
The examination by a doctor in case of acute traumatic spinal disorders and deformities of the spine require a special approach.
Essentials of a routine physical examination of the spine
• With the Patient in underwear, observe the Patient’s gait, movements, the spine’s lateral and coronal curvature, variation in circumference between the limbs, lower extremity length difference, possible deformities and other important anatomical indicators;
• Perform a functional examination with the Patient standing, sitting, lying on the back, on the stomach and on the side. Check the movements of the regions and extremities three ways in three different levels: passive movement doctor activated, active movement, and active movement against resistance;
• Neurological testing (reflexes, motor and muscle strength, sensory disturbance) always comparing both sides.
Answers obtained through physical examination
• The general spinal structures causing the pain may be more or less determined (be it of intervertebral disc, facet joint, root or sacroiliac origin).
• The spine’s functional capacity determined.
• We may gain information regarding complaints imitating spinal disorders and diseases of differential diagnosetic significance (disorders of the arteries and veins of the extremities, organic, neurological, internal medicine, urological and gynecological diseases, polyneuropathy and tunnel syndromes).
• The neurological function of the extremities (sensory, reflex, motor disorders) will provide us with information regarding the location of the root involved.
• Through special tests and maneuvers, overreaction to pain, which might otherwise confuse the validity of the examination and help identify simulation, may be screened out.
• In the case of spinal chord injury, answers may be obtained as to its location and the extent of the injury suffered.
We must remember, however, that the diagnostic value and accuracy of physical examinations are influenced by various factors. Essentially important is a test’s reproducibility - in other words, when repeating the same tests on the same Patient, the same results should be obtained. Another important factor is validity - that is, compared to a gold standard, what is the likelihood that a given test reaffirms or contradicts a diagnosis. A test’s sensitivity and specificity to a given clinical picture may modify the latter. Sensitivity measures the proportion of actual positives which are correctly identified as such (e.g. the percentage of sick people who are correctly identified as having the condition) while specificity measures the proportion of negatives which are correctly identified (e.g. the percentage of healthy people who are correctly identified as not having the condition). Sensitivity and specificity are a test’s own constant characteristics. The analysis of various tests are in the forefront of research today from the standpoint of validity and reproducibility in order to create the most perfect and unified creditable test methods.
In summary, we may state that no one test or method has diagnostic value in and of itself. There are tests with specificity and sensitivity that are significant in a given disease, but for setting up a correct diagnosis, the precise physical examination is the leader.