What is the focus of the physical exam to evaluate mechanical back pain?

Updated: Aug 27, 2020
  • Author: Debra G Perina, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Physical examination of a patient with back pain should include range of motion and a thorough neurologic examination, including assessment of peripheral motor function, sensation, and deep tendon reflexes. [21]

Perform straight leg testing with the patient in a supine position. Record response to raising each leg. An approximation of the test may also be performed with the patient sitting and each leg straightened at the knee. An elevation of the leg to less than 60° is abnormal. The straight leg test result is positive only if the pain radiates to below the knee and not merely in the back or the hamstrings. This is the single best test for determining radiculopathy due to disc herniation with a high sensitivity and moderate specificity. [22]

Perform an abdominal examination to exclude intra-abdominal pathology.

Men older than 50 years should be given a rectal examination to assess prostate size and exclude prostatitis. Also perform a rectal examination on any patient who may have cauda equina syndrome to assess rectal tone and perineal sensation. If cauda equina syndrome is suspected, urinary catheterization for a post void residual or bedside ultrasonography of the bladder may be helpful to assess for urinary retention. Perform a rectal examination, if necessary, in younger males who are febrile and have urinary complaints.

 A pelvic examination should be done in females complaining of menstrual abnormalities or vaginal discharge.


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