Spinal examination

Test or Sign

Technique and Interpretation

Babinski reflex

Extensor plantar response on stroking sole of foot suggesting UMN lesion

Spurling’s test

Examiner turns the patient’s head to the affected side while extending and applying downward pressure to the top of the patient’s head (foraminal compression). A positive test (Spurling’s sign) is when the pain arising in the neck radiates in the direction of the corresponding painful dermatome ipsilaterally

Hoffman’s test

Quickly snapping or flicking the middle fingernail; if positive, the tip of the index finger, ring finger, and/or thumb suddenly flex in response, and this indicates cervical myelopathy

Inverted radial reflex

Said to be present when the supinator reflex associated with the brachioradialis muscle elicits finger flexion (abnormal) rather than elbow flexion (normal). This is due pathology causing to an absent biceps jerk (C5-C6) and an exaggerated triceps jerk (C7). It occurs because a lower motor neuron lesion of C5 root is combined with an upper motor neuron lesion affecting reflexes below C5

Finger escape sign

Ask the patient to hold fingers extended and adducted. Little finger spontaneously abducts and flexes due to weak intrinsic muscles indicating cervical myelopathy

Lhermitte’s sign

Electric shock-like sensation shooting down the spine when flexing the cervical spine

Scratch along the crest of the patient’s tibia in a downward motion. A normal (negative) response is no reaction. An abnormal (positive) response is an extensor plantar response suggesting upper motor neuron lesion. It is one of a number of Babinski-like responses. The sign's presence indicates a damage to the pyramidal tract.

Adam’s test

Not reliable in the presence of lower limb length discrepancy. The patient bends forward at the waist until the back comes in the horizontal plane, with feet together, arms hanging and knees extended. The palms are held together. The examiner looks from behind, along the horizontal plane of the column vertebrae. The examiner looks for indicators of scoliosis, such as spinal asymmetry, nonlevel shoulders, scapula asymmetry, nonlevel hips, the head that does not line up with the pelvis or a rib hump. An increased or decreased lordosis/kyphosis can also be a sign for scoliosis. The rotation deformity or rib hump can be measured with a scoliometer

Schober’s test

A mark is made at the level of the posterior iliac spine on the vertebral column, i.e. approximately at the level of L5. The examiner then places one finger 5 cm below this mark and another finger at about 10 cm above this mark. The patient is then instructed to touch his toes. If the increase in distance between the two fingers on the patients spine is less than 5 cm then this is indicative of a limitation of lumbar flexion

Femoral stretch test

Knee is passively flexed and the hip is passively extended with the patient in the prone position. Test is positive if results in anterior thigh pain, most often in L2-L3 and L3-L4 disc herniation (less so or negative in L4/5 and L5/S1 herniation)

Lasegue’s test

Straight leg raise. Positive for herniated disc if the patient experiences sciatica when the straight leg is at an angle of 30-70°

Bowstring test

Performed after a positive straight leg raise is elicited; the angle of hip elevation is decreased to decrease the radicular pain and then pressure is applied to the popliteal fossa, over the nerve, to reproduce symptoms

Abdominal reflex

Stroke on the abdominal skin from lateral to the medial aspect in all four quadrants A normal positive response usually involves a contraction of the abdominal muscles, and the umbilicus moving towards the source of the stimulation. Polysynaptic T7-T12 reflex. Absence can be pathological or physiological (e.g. obesity, multiparity, tolerance, children)

Bulbocavernosus reflex

Polysynaptic S2-S4 reflex. Monitoring internal/external anal sphincter contraction in response to squeezing the glans penis or clitoris, or tugging on an indwelling Foley catheter. In the context of acute spinal cord injury, absence suggests spinal shock, whereas presence suggests a severed cord. It is one of the first reflexes to return after spinal shock at 48 h. Absence after lumbar trauma may be due to conus medullaris or cauda equina injury

Shoulder abduction test

Patients with radiculopathy have improvement of their symptoms with elevation of the arm above the head. This is an important test to distinguish cervical pathology from other sources of shoulder/arm pain

Using LP to check OP to see if it increases with a raised in ICP via abdominal pressure or external jugular compression. To check for spinal stenosis

to differentiate between radiculopathy vs common peroneal nerve injury for foot drop

Superficial abdominal reflex

They are performed by stroking each four quadrants of the abdomen and the normal response is the movement of the umbilicus toward the stroked segment.
It is an upper motor neuron reflex and asymmetry suggests intraspinal (upper motor neuron) pathology.