Physical examination maneuver

Physical Exam

T L Spine and Back Palpation

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Video coming September 2026

How to Perform

Palpate the thoracic and lumbar spine and the surrounding back, comparing sides. Run the fingers down the spinous processes feeling for alignment, step-off, or tenderness, then palpate the paraspinal muscles, the sacroiliac regions, and the costovertebral angles. Note any midline bony tenderness, paraspinal tenderness or spasm, step-off, or masses.

How to Interpret

Showing 1 of 2 findings

Vertebral Fracture or Spinal Malignancy

Midline bony (spinous-process) tenderness on palpation of the thoracic or lumbar spine
Rule in
Minimally helpful
Rule out
Somewhat helpful
Evidence:Limited

References

  • Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988 May-Jun;3(3):230-238. doi:10.1007/BF02596337. PMID 2967893.
  • Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, Hendershot EF, Holtom PD, Huddleston PM 3rd, Petermann GW, Osmon DR; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015;61(6):e26-e46. PMID 26229122. doi:10.1093/cid/civ482.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Related Systems / Regions

MusculoskeletalPelvisThorax

Related Bedside Tests

🎬Video coming Sept 2026
Spine Inspection
Rule in:SHVertebral Compression Fracture, IEScoliosis
Rule out:IEScoliosis
🔒Sign in
Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more
🎬Video coming Sept 2026
Carotid Artery Palpation
Rule in:HAortic Stenosis, HTakayasu Arteritis, SHAortic Dissection +7 more
Rule out:SHAortic Stenosis, IEAortic Regurgitation, IECarotid Artery Stenosis +5 more
🎬Video coming Sept 2026
FABER Test
aka Patrick's test
Rule in:IESacroiliac Joint Pathology
Rule out:IESacroiliac Joint Pathology
🎬Video coming Sept 2026
Hip Palpation
Rule in:IEGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEProximal Hamstring Tendinopathy, IEPubic-related Groin Pain
Rule out:IEGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEProximal Hamstring Tendinopathy, IEPubic-related Groin Pain
🎬Video coming Sept 2026
Hip Strength
Rule in:VHGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more
Rule out:HGluteal Tendinopathy (Greater Trochanteric Pain Syndrome), IEAdductor-related Groin Pain, IEIdiopathic Inflammatory Myopathy (Polymyositis or Dermatomyositis) +1 more