Examination notes

What do you look for during gait and initial observations?

Look at the sagittal and coronal planes of the patient. In the sagittal plane a vertical line should be drawn through the ear, shoulder, hip, knee and ankle. This quick screening test helps identify any spinal deformity, for example found in ankylosing spondylitis.

What signs should be identified in examining the skin?

The skin needs to be assessed for signs of systemic disease:

1. • Café-au-lait spots found in neurofibromatosis.

2. • Psoriasis, cutaneous vasculitis or nodules found in rheumatoid arthritis.

3. • Evidence of steroid use with striae, telangiectasia, skin thinning and bruising.

4. • Scars: evidence of previous cervical spine surgery via a posterior or an anterior approach (where a scar is found in the skin crease medial to the sternocleidomastoid).

How should the soft tissues be inspected?

The symmetry of the surrounding soft tissues and muscles are assessed:

1. • Anteriorly: the scalene, sternocleidomastoid and pectoralis muscles.

2. • Posteriorly: the paraspinal muscles (levator scapulae, trapezius, rhomboid and trapezius muscles) are palpated.