Ankylosing Spondylitis

Look (Standing)

  • General Appearance:
    • Male, middle-aged adult.
    • Head translated forwards.
    • Decreased horizontal gaze.
    • “Question mark” posture.
    • Loss of cervical and lumbar lordosis.
    • Kyphotic deformity of the thoracic spine.
    • Flexed attitude of hips and knees.
  • Eyes: Check for uveitis.

Feel (Standing)

  • Pain:
    • Over sacroiliac joints (SIJ).
    • Throughout the spine (indicative of Romanus lesions or pseudoarthrosis).
  • Chest Expansion:
    • Measure at the nipple level; should be at least 7 cm.

Move (Standing)

  • Walking Assessment:
    • Observe gaze pattern while walking.
    • Assess for hip or knee flexion contractures.
  • Stiff Cervical Spine:
    • Measure forward gaze angle.
    • Assess chin-brow angle.
    • Check for absence of lateral bend.
    • Measure occiput-to-wall distance.
  • Stiff Thoracic Spine:
    • Inability to flatten the back against a wall.
    • Loss of rotation with pelvis fixed.
  • Stiff Lumbar Spine:
    • Reduced flexion on Schober’s test.

Lie Down

  • Posture:
    • Unable to rest head back without pillows.
  • Tests:
    • Perform FABER test for sacroiliitis.
    • Assess the range of motion (ROM) in hips and knees for any fixed flexion.

Finishing Steps

  • Conduct a full neurologic and vascular examination.

History

  • Gather a detailed history relevant to ankylosing spondylitis.

Imaging

  • Order X-rays to confirm diagnosis and assess structural changes.
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