3. Evaluation Of The Lumbar Spine And Pelvis Flashcards
What evaluation of lumbar spine and pelvis can be done in the standing position?
- superficial inspection of skin and bony landmarks
- postural evil
- global range of motion
- SI motion palpation using piedau’s test
- flexion/extension evaluation using Gillet’s test
In piedau’s test, separation of PSIS and sacral apex should occur when patient flexes forward indicating that the sacral base has moved______ relative to the ilia.
posteriorly
Using Peidau’s test, dysfunction is suspected on the side where PSIS starts ____ and ends _____
Inferior, superior
What is it called when a normally painless stimuli produces pain?
Allodynia
Physical evaluation of the lumbar spine and pelvis in the prone position would include?
- observation
- static palpation (soft tissue, bony)
- motion palpation (flexion, extension, rotation and lateral flexion in the lumbar spine + flexion and extension in the SI)
- leg length evaluation
If leg length inequality exists with straight legs in a prone position and the discrepancy persists with knees bent to 90, what does this mean?
There is an anatomical inequality of Tibia/fibula
If leg length inequality exists with straight legs in a prone position and the discrepancy disappears with knees bent to 90, what does this mean?
Either there is an anatomical femoral inequality or the leg length inequality is functional
Physical evaluation of the lumbar spine and pelvis in side posture would include:
- lumbar segmental motion palpation (flexion/extension, rotation, lateral flexion)
- SI motion palpation (flexion/extension)
Physical evaluation of the lumbar spine and pelvis in sitting would include:
- Lumbar motion palpation (PA scan, sectional and segmental motion palpation)
- SI motion palpation (PA glide, sacral/iliac shear, sacral push, leg flare, Piedau’s test)
When doing SI motion palpation in the sitting position, what is the difference between PA glide and sacral push?
- PA glide: patient is in neutral seated position and doctor uses fist to press on sacrum
- sacral push: patient leans back a bit and doctor uses both thumbs to press on sacrum
Physical evaluation of the lumbar spine and pelvis in supine would include:
- leg length evaluation (Allis test and sit up test)
- palpation of pubic symphysis (static and motion with hip hike)
Allis test is useful for detecting what type of leg length inequality?
- Tib/fib inequality
- femoral inequality
How is the sit up test useful in assessing leg length inequality?
Helps to determine if LLI is anatomic, functional or both
If relative leg lengths remain the same from supine to sit up, what does this mean?
The leg length inequality is anatomic
If relative leg lengths change from supine to sit up, what does this mean?
The leg length inequality is functional
A flexed (PI) ilium will _____ (lengthen or shorten) on sit up set?
Lengthen
A flexed ilium (PI) positions the acetabulum more cephalad and anterior.
When supine, acetabular superiority of the flexed ilium (PI) makes the leg appear shorter.
When sitting, acetabular anteriority of the flexed ilium (PI) makes the leg lengthen
A extended (AS) ilium will _____ (lengthen or shorten) on sit up set?
Shorten
An extended ilium (AS) positions the acetabulum more caudad and posterior.
When supine, acetabular inferiority of the extended ilium (AS) makes the leg appear longer.
When sitting, acetabular posteriority of the extended ilium (AS) makes the leg shorten.
How would you test for nerve root compression of irritation affecting sensory (dermatomal) function?
- light touch
- pin prick
- vibration
How would you test for nerve root compression or irritation affecting reflex function?
- DTR’s
- superficial reflexes
Pain from nerve root compression or irritation causing sharp shooting pain is called:
Radicular pain
What is sclerotogenous pain?
referred pain from deep somatic structures that causes deep, dull, achy, hard to localize, diffuse pain that has different referral areas than radicular pain
What are the nerve traction tests used in orthopedic (provocative) testing of the lumbar spine and pelvis?
- straight leg raising
- Braggard’s test
- bow string test
They are often done as a group
When performing the straight leg raising test for nerve traction, what does it mean when symptoms are produced or exacerbated between 0-35 degrees?
Extradural sciatic involvement is suspected such as piriformis syndrome because there is no nerve root traction or lumbar joint movement in this range
When performing the straight leg raising test for nerve traction, what does it mean when radicular pain into extremities occurs between 35-70 degrees?
In this range sciatic nerve roots tense over the IVD causing further irritation to a sensitive nerve root, so would suspect IVD lesion, or nerve root compression/irritation
When per forming the straight leg raising test for nerve traction, what does it mean when pain occurs in the lumbar between 70-90 degrees?
Nerve roots are fully stretched at this pointe to the likely cause of pain is lumbar orthopedic in nature
Braggard’s test is used as a follow up/confirmation of the straight leg raise test if radicular pain was found between 35-70 degrees. How is this done?
patient supine, raise leg to the point of leg pain found in SLR, lower leg a few degrees and dorsiflex the foot to retention the sciatic nerve. If radicular pain occurs, this is confirmation of IVD lesion or nerve root compression/irritation
Bowstring test is used as a follow up/confirmation of the straight leg raise test if radicular pain was found between 35-70 degrees. How is this done?
patient supine, support their leg on your
shoulder or under your arm, use fingers or thumbs to exert firm pressure on the hamstrings tendons and into the popliteal fossa to increased sciatic nerve tension. If radicular pain occurs, this is confirmation of IVD lesion or nerve root compression/irritation
What tests can be used as SI/lumbar differential tests?
- Goldthwait’s
- supported forward bending test
How would you perform Goldthwait’s test?
Patient is supine, The Dr.’s palpating hand is under the patient’s lumbosacral region with fingertips on the sacral base and in the interspinal spaces, the Dr. elevates the leg.
How would you perform the supported forward bending test?
Dr. stands behind the standing patient, reaches
in front of patient and pulls patient against Dr.’s hip by contacting ASIS’s so as to stabilize the pelvis, patient flexes forward at the waist
When performing Goldthwait’s test, If low back pain is brought on before the lumbar spine begins to move, what is suspected?
an SI lesion is suspected.
When performing the supported forward bending test, if low back pain is absent, what is suspect?
an SI lesion is suspected.
When performing the supported forward bending test, if low back pain is reproduced or aggravated, what is suspect?
Lumbar lesion suspected
In the active straight leg raise, a supine patient raises each leg several inches off the table. If no pain or difficulty results, the practitioner may apply pressure downward on the leg to increase the load on the SI joint. Significant results suggesting pelvic/SI instability/irritation:
- Familiar/localized pain
- Difficulty raising the leg - Inability to raise each leg to a comparable height
- Poor ability to resist the examiner’s downward pressure
How would you perform the Patrick FABER test?
patient supine, Dr. flexes, abducts and externally
rotates the hip resting the ankle on the contralateral knee, pushes down on flexed knee while stabilizing opposite ASIS
hip pain indicates hip problem
SI pain indicates SI problem
How would you perform the thigh thrust test?
The evaluator positions the hip of the supine
patient in about 90º of flexion and slight adduction (approximating the angle of the SI joint), then applies gradual downward pressure along the axis of the femur.
Localized SI pain suggests joint pathology/dysfunction
Localized hip pain suggests a hip lesion.
How would you perform Gaenslen’s test?
patient supine, Dr. flexes knee and thigh of
unaffected side toward patient’s chest, pushes down on affected side leg which may be hanging over the side of the table. flexing unaffected leg stabilizes the lumbar spine, pushing other leg down produces extension of the SI on the affected side. pain on the affected side indicates SI lesion
How would you perform the sacroiliac stretch test?
patient supine, Dr. crosses arms and applies
downward and lateral pressure on ASIS’s to stretch anterior portion of SI joints. Pain indicates SI lesion (probably sprain of the anterior sacroiliac ligament
How would you perform the sacroiliac compression test
patient lying on side, Dr. presses downward on
the ilium to compress the SI joint, more posteriorly. pain in SI joint indicates SI lesion
How do you preform the sacral thrust?
The practitioner applies a P-A thrust (not HVLA) to the midline of the sacrum at about the S2-3 level on the prone patient to create a shearing force along the SI joints, stressing the anterior and posterior ligaments. Localized SI pain suggests joint pathology or dysfunction.
How would you perform HIbb’s test?
patient prone, Dr. flexes patient’s knee toward the
buttock and moves the leg outward causing internal rotation of the hip which distracts the SI joint. SI pain indicates SI joint lesion. hip pain indicates hip lesion
How would you perform Yeoman’s test?
patient prone, Dr. flexes patient’s knee and lifts
patient’s knee off the table to extend the hip while stabilizing ipsilateral PSIS. This produces SI extension on the side being tested which stresses the SI joint and anterior sacroiliac ligament. SI pain indicates SI lesion (probably sprain of anterior sacroiliac ligament)
