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.