Ankylosing spondylitis

Introduction

This is classic long case material. There are good clinical signs present with a lot to talk about and discuss afterwards with the examiners.

Memorandum

On general inspection we have a male patient who is somewhat stooped as he walks into the room. On examination from behind the shoulders are of equal height, there is loss of normal lumbar lordosis, a fixed kyphosis of his thoracic spine and a forward thrust of his cervical spine. From the front his head appears to be translated forwards but his visual axis is just about horizontal. His pelvis is level but he tends to stand with a slightly flexed attitude of his hips and knees.

On examination of his neck movements there was very limited flexion and extension present. There is almost no lateral movement of his cervical spine. Examining his lumbar spine reveals a gross restriction of all movements. In particular he tends to flex his hips when bending forwards to compensate for a stiff spine.

The patient has a classic question mark posture with pronounced thoracolumbar kyphosis and flexion deformities of the hip.

Schober's test for lumbar forward flexion was 3 cm (normal=5 cm or more), which is markedly reduced. The wall test unmasks a flexion deformity of the spine. He is unable to stand with his back flush against the wall. Forced flexion, abduction and external rotation of the hip joint (Faber test) produces severe pain of the sacroiliac joints.

Maximum chest expansion from full expiration to full inspiration measured at the level of the nipples is reduced to 3 cm compared to a normal expansion of 7 cm.