3. Back & Hip Tests & Disorders Flashcards
Straight Leg Raise Test
Assesses for sciatica; passively flex hip w/ knee straight; lower leg slightly; dorsiflex (+) finding is pain in sciatic n. at any point
Opposite Straight Leg Test
Assesses for sciatica in opposite leg; passively flex unaffected hip with straight knee
Hoover Test
Tests for fakers; should feel pressure from opposite foot when asking patient to raise a leg
Patrick’s Test
Tests SI joint, Adductor muscle tightness; Ligament tightness
Pelvic Rock Test
Tests for pelvic fracture; Providers hands on ASIS bilat; press inward then down & out; (+) = pain with minimal pressure
Beevor’s Sign
Tests abdominal muscle weakness; observe umbilicus during crunch. (+) = umbilicus moves to stronger, uninvolved side
Trendelenburg Test
Tests for weak glut medius; Patient stands on one leg; (+) on weight-bearing leg if opposite hip drops
Ober Test
Test for IT band tightness; Pt in lat decub on unaffected side, passively flex knee to 90, abduct hip, release leg; (+) = leg does not drop
Modified Ober Test
Test for IT band tightness; Pt in lat decub on unaffected side, passively flex knee to 90, abduct & extend hip, release leg; (+) = leg does not drop
Piriformis Test
Test for piriformis strain or tightness; Pt in lat decub on unaffected side; knee flexed; passively adduct hip & press medially; (+) pain at location of piriformis
Femoral Nerve Test
Pt in lat decub on unaffected side; passively extend hip and flex knee to 90 to stretch femoral n. (+) = pain or paresthesias along femoral n.
Thomas Test
Test for tight hip flexors; pt supine, actively flex one hip & knee to chest & hold; (+) = extended leg flexes off table
Kendell Test
Test for tight rectus femoris; pt supine with one glut off table, actively hug both knees to chest, drop one leg off table; (+) = hanging leg straight at knee
Nobel’s Test
Test for IT band syndrome; pt supine with knee flexed, apply pressure lat to knee while extending; (+) = pain experienced at IT band at 30 flexion
Renne’s Test
Test for IT band syndrome; pt stands on affected leg, actively flexes to 30-40; (+) = pain experienced at IT band at 30 flexion
Low Back Muscle Strain – Mechanism
Mechanism = forceful contraction or overstretch
Low Back Muscle Strain – S/Sx
S/Sx = Pain, edema, muscle spasm, RoM affected depends on muscle
Low Back Ligament Sprain – Mechanism
Mechanism = Sudden hyperextension w/ trunk rotation; faulty posture
Lumbar Disc Herniation
Intervertebral disc bulges or ruptures; places pressure on spinal nerves exiting intervertebral foramen
Lumbar Disc Herniation – Protrusion
Disc bulges posteriorly or laterally; no rupture
Lumbar Disc Herniation – Prolapsed
Outermost fibers of Anulus contain nucleus pulposis
Lumbar Disc Herniation – Extrusion
Anulus perforated, portion of nucleus moves into epidural space
Lumbar Disc Herniation – Sequestrated
Nucleus pulposis outside of disc
Spina Bifida
Birth defect; lack of fusion of neural arch of one or more vertebrae; weakness in region; Possible loss of stability due to muscle and ligament attachment; spinal cord may protrude
Sacroiliitis
Inflammation of SI joint; excessive movement of joint; common in pregnancy; point tender at SI joint; pain with sitting on hard surface; pain with lying on supine on hard surface; pain-free when standing
Spondylosis
Degeneration of intervertebral disc
Spondylolysis
Scottie Dog Fracture/Stress fracture; Defect in articular processes of vertebra (fx); Repeated hyperextension & hyperflexion; L5-S1; L4-L5; possibly asymptomatic; Unilateral LBP, radiates to opposite side; increased pain with lat rot, limited ext
Spondylolisthesis
Scottie Dog Decapitated; Forward slippage of superior vertebra on inferior one; Radiating LBP; Limited hip flexion, trunk ext
Ankylosing Spondylitis
Fusion of cervical vertebrae & SI joint; Males 20-40 yrs; Genetic; Achilles tenosynovitis; Uveitis
Cauda Equina Syndrome
Saddle anesthesia; buttocks, posterior upper & lower legs; paralysis; bladder & bowel incontinence
Hip dislocation
Joint very stable; occurs when knee is flexed; posterior (90%)
Anterior hip dislocation
10% of hip dislocations; Leg shortened; ABD; flex; ER; Medical emergency due to potential FEMORAL NERVE damage
Posterior hip dislocation
90% of hip dislocations; MVA most common mechanism; HIP & KNEE FLEXED WITH IR & ADD; SCIATIC NERVE DAMAGE POSSIBLE
Congenital Hip Dislocation
Born with dislocation; Galeazzi’s Sign
Galeazzi’s Sign
Knee lower on dislocated side when placed on firm surface with hips and knees flexed; indicative of congenital hip dislocation
Ortolani’s Sign
Passively abd hip; (+) = click palpable or audible due to reduction; sign of congenital hip dislocation
Hip fracture – Location
1) femoral neck; 2) Intertrochanteric line
Hip fracture – Mechanism
Mechanism = Trauma, twisting
Hip fracture – S/Sx
Pain in groin, anterior thigh; Loss of IR; Hip held in ER; Shock likely
Slipped Capital Femoral Epiphysis
BOYS 10-17 YRS.; slipping of epiphyseal line due to prolonged stress; Limping in ER; Affected limb is shorter; Limited ABD, FLEX, IR; No Hx of injury; pain in groin, ant thigh, and referred to knee
Slipped Capital Femoral Epiphysis – Complication
Avascular necrosis; cell death due to lack of O2
Legg-Hipp-Perthes Disease
BOYS 3-12 YRS; blood supply to femoral head is interrupted & avascular necrosis develops; flattening of articular cartilage; necrosis of tissue; UNEXPLAINED LIMP; SHORTENED LIMB; DECREASED HIP ROM; pain in groin and ant thigh; Pain referred to abdomen or knee
Ischial bursitis – Mechanism
Overuse; direct trauma; SITTING ON HARD SURFACE FOR EXTENDED PERIOD OF TIME; falling on butt
Ischial bursitis – S/Sx
Point tender; pain with extension
Trochanteric Bursitis – Mechanism
Overuse, direct trauma, SYSTEMIC INFECTION
Trochanteric Bursitis – S/Sx
Pain, edema, crepitus, decrease abduction
Gluteus Max Strain – Mechanism
Forceful contraction, overstretching;
Gluteus Max Strain – S/Sx
S/Sx = Hx of sudden sharp pain & weakness; pain; decrease RoM w/ extension; point tender; may palpate defect
Hip flexor strain – muscles
Iliopsoas; Rectus femoris
Groin Strain – muscles
Adductors; Gracilis
Gluteus Medius strain – S/Sx
Point tender; REFERRED PAIN INTO GLUTS; (+) Trendelenburg
Piriformis Strain
SI joint pain; gluteal pain which radiates down back of thigh into gastroc
Sciatica – S/Sx
S/Sx = Pain in sciatic notch; Radiates down leg;
Sciatica – Mechanism
Mechanism = Direct blow to nerve; COMPRESSION DUE TO PIRIFORMIS MUSCLE STRAIN
Contusion – Mechanism
Mechanism = Direct blow
Contusion – S/Sx
S/Sx = Pain, edema, ecchymosis
Contusion complication
Myositis ossificans
Common contusion areas
Greater trochanter; Crest of ilium; Coccyx
Sprains – Mechanism
Mechanism = Violent twist; external blow; foot planted & trunk forced in opposite direction
Sprains – S/Sx
S/Sx = Pain w/ add, abd, flex; inability to circumduct leg
Lateral Femoral Cutaneous Nerve Impingement
Nerve impinged; numbness anterior, lateral thigh; Direct blow, edema, trauma
Osteoarthritis
> 50 yrs; pain in groin, referred to knee; pain with activity; stiffness,edema, limping; Held in ER
Biceps – Nerve & Nerve root for DTRs
Musculocutaneous – C6
Brachioradialis – Nerve & Nerve root for DTRs
Musculocutaneous – C6
Triceps – Nerve & Nerve root for DTRs
Radial – C7
Patellar – Nerve & Nerve root for DTRs
Femoral – L4
Achilles – Nerve & Nerve root for DTRs
Tibial/Sciatic – S1
Trapezius - Myotome
C4
Deltoid – Myotome
C5
Biceps – Myotome
C6
Triceps – Myotome
C7
Finger flexors – Myotome
C8
Finger abductors – Myotome
T1
Thumb opposition – Myotome
T1
Quadriceps – Myotome
L4
Great toe extension – Myotome
L5
Gastrocnemius – Myotome
S1
Rectal sphincter – Myotome
S3/4
Posterior upper head - Dermatome
C2
Tip of shoulder – Dermatome
C5
Thumb – Dermatome
C6
Middle finger – Dermatome
C7
Little finger – Dermatome
C8
Nipples – Dermatome
T4
Umbilicus – Dermatome
T10
Groin – Dermatome
L1
Medial knee – Dermatome
L3
Ant. Knee & Med. ankle – Dermatome
L4
Great toe, dorsum of foot – Dermatome
L5
Lat. Ankle & Little toe – Dermatome
S1
Heel & Plantar – Dermatome
S2
Perianal area – Dermatome
S5
Light touch spinal tract
Dorsal column
Tactile discrimination
Dorsal column
Pressure/Deep Touch
Ant. Spinothalamic
Vibration
Dorsal column
Joint position
Dorsal column
Pain
Lat. Spinothalamic
Temperature
Lat. Spinothalamic
Balance, Proprioception
Spinocerebellar
Somatosensory pathway
Sensory stimulus > SC/Brainstem > Thalamus
1st Order Neurons
Peripheral nerves to medulla
2nd Order Neurons
Medulla to thalamus
3rd Order Neurons
Thalamus to cerebrum
1st Order Neurons – Dorsal Column
Ipsilateral; lesion of spinal nerves or spinal tract
2nd Order Neurons – Dorsal Column
Contralateral; Medulla > crossover > thalamus
3rd Order Neurons – Dorsal Column
Contralateral; Thalamus > Sensory cortex > Postcentral (upper limbs) & paracentral (lower limbs) gyrus
1st Order Neuron – Spinothalamic
Ipsilateral; SC > Dorsal horn
2nd Order Neuron – Spinalthalamic
Contralateral; Dorsal horn SC > crossover > Spinalthalamic tract to thalamus
3rd Order Neuron – Spinalthalamic
Contralateral; Thalamus > Sensory cortex
Lesion in Spinal Nerve – Dorsal Column
Ipsilateral impairment
Lesion in Spinal Nerve – Spinothalamic
Ipsilateral impairment
Lesion in SC Tract – Dorsal Column
Ipsilateral impairment
Lesion in SC Tract – Spinothalamic
Contralateral impairment
Motor Pathway
Corticospinal tract
Lesion in Spinal Nerve – Corticospinal tract
Ipsilateral impairment
Lesion in SC Tract – Corticospinal tract
Ipsilateral impairment
Signs of Lower Motor Neuron Lesion
Decreased muscle tone (flaccidity); Decrease or absent DTR
Signs of Upper Motor Neuron Lesion
Increased muscle tone (spasticity); Increased DTR or clonus
