2.1 Spinal Tests for Impairments Flashcards
Tests for disc herniation or space occupying lesion:
L-spine
- SLR: numbness/tingling/pain travelling down the leg being tested
- WLR: reproduction of symptoms down affected leg, usually at 40° or less
- Slump: reproduction of S/S that are then relieved when head or knee is returned
- Milgram’s: pain and/or inability to raise/hold leg off table
- Bowstring: reproduction of symptoms; if severe, nerve will feel like braided cord
L- or C-spine
- Valsalva: reproduction of symptoms either locally in spine or down leg/ radicular pain patterns down arm
C-spine
- Tinel’s Sign: tingling sensation in the distribution of nerve on ips side
What are tests for spondys, instability or muscle weakness?
L-spine
- Pheasant: hyper-lordotic presentation in L-spine and/or pain in lower limb
- Segmental Instability: LBP with pressure when px is relaxed & no pain when contracting
C-spine
- Sharp-Purser
C- and L-spine
- Mm tests: weakness
What are tests for Facet irritation?
L-spine
- Kemps: localized pain on ips side
L- & C-Spine
-
Myotome/Dermatome/DTR:
- Derm: brush BL 7-10 times and ask about any altered sensation
- Myo: looking for weakness of all mm innervated by single nerve root
C-spine
- Cervical Upper/Lower Quadrant tests: local pin-point pain; referral pain that follows apophyseal joint referred pain patterns
What are tests for nerve compression in the L-spine?
- Slump: reproduction of S/S that are then relieved when head or knee is returned
- Fem N Stretch/Nachlas test: reproduction of pain or paresthesia over L2 and/or L3 and/or L4 dermatome area (low back & ant thigh region) may indicate lesion or irritation to fem nerve
- Bowstring: reproduction of symptoms; if severe, nerve will feel like braided cord
- SLR: numbness/tingling/pain travelling down the leg being tested
- WLR: reproduction of symptoms down affected leg, usually at 40° or less
- (possibly Myotome/Dermatome/DTR)
What are tests for nerve root compression?
L-Spine
- Kemps: localized pain on ips side
- (possibly motion palp)
- (possibly SLR, WLR)
C-Spine
- Spurling’s test/Foraminal Compression test: pain radiating into arm toward which head is flexed during compression
- Cervical Compression test: pain radiating into arm toward which head is flexed during compression
- Distraction test: pain relieved or decreased when head is distracted (pain further alleviated if px lift arms above head)
C- or L-spine
-
Myotome/Dermatome/DTR:
- Derm: brush BL 7-10 times and ask about any altered sensation
- Myo: looking for weakness of all mm innervated by single nerve root
What are tests for degenerative disc disease?
L-spine
- SLR: numbness/tingling/pain travelling down the leg being tested
- WLR: reproduction of symptoms down affected leg, usually at 40° or less
- Slump: reproduction of S/S that are then relieved when head or knee is returned
- (possibly seg. instability)
L- or C-spine
- Valsalva: reproduction of symptoms either locally in spine or down leg/ radicular pain patterns down arm
What are tests for spinal muscle tightness?
- MM tests
- Myotome/Dermatome/DTR
What are vascular tests for the C-spine?
- Hautant’s test: if arms move without neck rot & ext, non-vascular; with rot & ext, vascular
What are tests for ligament instability in C1-C2?
- Tranverse Lig Stress test: soft end feel; mm spasm, dizziness, nausea, pareshtesia of lip, face, limb, nystagmus, lump sensation in throat
What are muscle tests for the L-spine?
- QL: can’t be tested individually, but it’s the best test we’ve got atm
- Lat Dorsi: px prone, attempts to adduct arm in position of ext and med rot
- Lower Abs: be sure to palpate L-spine to check if it comes off table
What are muscle tests for the C-spine?
Test all against gravity first
- Ant neck flxrs: elbows bent and hands overhead, resting on table
- Anterolateral neck flxrs: elbows bent and hands overhead, resting on table
- Posterolateral neck extnsrs: elbows bent and hands overhead, resting on table
- Upper Traps: shoulder elevated and head lat flx
- Levator Scap
What are the C1-C4 dermatomes?
There are none!
What are the C5-T1 dermatomes?
C5
Lat Shoulder
C6
Thumb & index finger
C7
Middle finger
C8
4th and little finger
T1
Med elbow
What are the L1-S2 dermatomes?
L1
Inguinal area
L2
Mid ant thigh
L3
Ant thigh prox to patella
L4
Patella, med leg, med aspect of foot
L5
Lat leg, dorsum foot, webspace btwn 1st two toes
S1
Lat malleolus and lat and plantar foot
S2
Back of leg and thigh
What are the Mytomoes of C1-T1?
C1-C2
Neck flexion
C3
Neck lat flx
C4
Shoulder elevation
C5
Shoulder abduction
C6
Elbow flex and wrist ext
C7
Elbow ext & wrist flx
C8
Thumb ext & uln dev
T1
Hand intrinsics
