FRCEM Revision Guide • Musculoskeletal OSCE Stations • St Emlyn's

Examiner / observer · 1 of 3

Back examination

Preparation · History

Provide a couch, tape measure, safe space and suitable neurological equipment. Agree a comfortable non-traumatic practice setting. Discuss red flags and intimate symptoms verbally; no rectal examination is performed on a partner.

History

Asks about pain location, radiation, trauma, weakness, fever, infection risk, cancer, weight loss and severe or progressive symptoms.

Asks specifically about new urinary initiation or flow-sensation change, saddle/genital sensory change, loss of rectal fullness, sexual dysfunction and progressive bilateral weakness.

Asks about inflammatory features: morning stiffness, night waking, improvement with movement, psoriasis, uveitis or inflammatory bowel disease.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 1 of 3

Examiner / observer · 2 of 3

Back examination

Cauda equina concerns · Nerve-root irritation

Cauda equina concerns

For possible cauda equina syndrome, states the need for urgent emergency-MRI-pathway assessment; negative examination findings do not rule it out. Key step

Does not use anal tone or a low post-void residual as reassurance; understands that a digital rectal examination is not required for GIRFT referral. Key step

Inspection and movement

Inspects standing posture and gait only when safe, noting spinal curves, scars and skin changes; avoids unsafe single-leg standing.

Gently assesses spinal and paraspinal tenderness, warmth, swelling and relevant deformity.

Assesses comfortable flexion, extension, rotation and lateral flexion without forcing movement.

Lumbar flexion

For modified Schober, marks 5 cm below and 10 cm above the PSIS level, measures increase with flexion and records technique and excursion.

Nerve-root irritation

Distinguishes familiar radiating pain during passive straight-leg raise from isolated back pain or hamstring tightness.

For crossed straight-leg raise, identifies reproduction in the opposite affected leg without claiming disc size or location.

Uses bowstring only as an optional trained-examiner adjunct, without forceful common-peroneal pressure or isolated diagnostic claims.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 2 of 3

Examiner / observer · 3 of 3

Back examination

Other focused tests · Finish

Other focused tests

Performs FABER gently with pelvic stabilisation and records groin versus posterior pain rather than naming a diagnosis from the test alone.

For femoral nerve stretch, distinguishes familiar anterior-thigh radicular pain from quadriceps stretch discomfort.

Completion

Completes lower limb neurological assessment and considers other pain sources as indicated.

Selects relevant hip/abdominal examination and investigation or referral, documenting limitations and explicit reassessment advice.

Finish

Thanks the patient.

Restores comfort and offers help with dressing where needed.

Ask the candidate

Which symptoms would change the urgency? Suspected cauda equina symptoms require the urgent pathway even with reassuring physical findings.

How would you interpret a nerve-tension test? Describes the familiar symptoms reproduced and their distribution, integrates neurological findings and avoids diagnosis from one test.

Feedback

What went well:

One thing to improve:

Try again focusing on:

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 3 of 3

Back examination

Your task

Starting information

Back examination

Back examination

Preparation

History

Back examination

Cauda equina concerns

Inspection and movement

Lumbar flexion

Nerve-root irritation

Back examination

Other focused tests

Completion

Finish

Ask the candidate

Feedback