Physical examination tests used to assess the severity of sacroiliac and spinal joint involvement in Axial Spondyloarthritis
• Occiput-to-wall test. Assesses the exaggerated kyphosis in more advanced disease. Normally with the heels and scapulae touching the wall, the occiput should also touch the wall. The distance from the occiput to the wall represents the magnitude of thoracic/cervical involvement. The tragus-to-wall test could also be used.
• Chest expansion. Detects limited chest mobility. Measured at the xiphisternum. Normal chest expansion varies by age and possibly sex, though usually abnormal if <2.5 cm and normal if ≥5 cm.
• Schober test (modified). Detects limitation of forward flexion of the lumbar spine. Place a mark at the level of the posterior superior iliac spine (dimples of Venus) and another 10 cm above in the midline. With the patient in maximal forward spinal flexion with straight knees, the distance measured between the marks should increase from 10 cm to at least 14.5 cm in a young adult male. Other spinal mobility tests will show diminution in lateral flexion and spinal rotation, illustrating that the patient has a global loss of spinal mobility. Lateral flexion is measured by having the patient stand with heels and back against the wall and hands flat on the lateral thighs (neutral position. The patient bends sideways towards the floor without bending the knees or lifting heels. The difference in the distance of the middle finger between neutral position and maximal lateral flexion (double headed arrow) is recorded and averaged for left and right sides.
• Controversial physical exam maneuvers of unclear reliability: pelvic compression, Gaenslen’s test, Patrick’s test (knee flexion, abduction, and external rotation or the FABER test). They also do not produce a quantifiable response. These maneuvers are not recommended.
