Evaluation of mobility should include attention to presence of severe pain or gait disturbances. The structures of the head, neck, and back should be exposed and palpated for point tenderness, deformity, or signs of infection. A thorough neurologic examination, including assessment of specific nerve roots' strength, sensation, and reflexes, is vital (Tables 177-2, 177-3). Exam maneuvers should be performed as indicated, and may include straight-leg testing or assessment for the Lhermitte sign (electric shock-like pain in the spine and extremities occurring with neck flexion, suggesting cord compression). A rectal examination to evaluate for tone, sensation, masses, or infection should be performed when there are neurologic deficits or concerns for serious disease.