3. Evaluation Of The Lumbar Spine And Pelvis

Question 1

What evaluation of lumbar spine and pelvis can be done in the standing position?

Answer 1

• 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

Question 2

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.

Answer 2

posteriorly

Question 3

Using Peidau’s test, dysfunction is suspected on the side where PSIS starts ____ and ends _____

Answer 3

Inferior, superior

Question 4

What is it called when a normally painless stimuli produces pain?

Answer 4

Allodynia

Question 5

Physical evaluation of the lumbar spine and pelvis in the prone position would include?

Answer 5

• 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

Question 6

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?

Answer 6

There is an anatomical inequality of Tibia/fibula

Question 7

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?

Answer 7

Either there is an anatomical femoral inequality or the leg length inequality is functional

Question 8

Physical evaluation of the lumbar spine and pelvis in side posture would include:

Answer 8

• lumbar segmental motion palpation (flexion/extension, rotation, lateral flexion)
• SI motion palpation (flexion/extension)

Question 9

Physical evaluation of the lumbar spine and pelvis in sitting would include:

Answer 9

• 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)

Question 10

When doing SI motion palpation in the sitting position, what is the difference between PA glide and sacral push?

Answer 10

• 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

Question 11

Physical evaluation of the lumbar spine and pelvis in supine would include:

Answer 11

• leg length evaluation (Allis test and sit up test)

- palpation of pubic symphysis (static and motion with hip hike)

Question 12

Allis test is useful for detecting what type of leg length inequality?

Answer 12

• Tib/fib inequality

- femoral inequality

Question 13

How is the sit up test useful in assessing leg length inequality?

Answer 13

Helps to determine if LLI is anatomic, functional or both

Question 14

If relative leg lengths remain the same from supine to sit up, what does this mean?

Answer 14

The leg length inequality is anatomic

Question 15

If relative leg lengths change from supine to sit up, what does this mean?

Answer 15

The leg length inequality is functional

Question 16

A flexed (PI) ilium will _____ (lengthen or shorten) on sit up set?

Answer 16

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

Question 17

A extended (AS) ilium will _____ (lengthen or shorten) on sit up set?

Answer 17

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.

Question 18

How would you test for nerve root compression of irritation affecting sensory (dermatomal) function?

Answer 18

• light touch
• pin prick
• vibration

Question 19

How would you test for nerve root compression or irritation affecting reflex function?

Answer 19

• DTR’s

- superficial reflexes

Question 20

Pain from nerve root compression or irritation causing sharp shooting pain is called:

Answer 20

Radicular pain

Question 21

What is sclerotogenous pain?

Answer 21

referred pain from deep somatic structures that causes deep, dull, achy, hard to localize, diffuse pain that has different referral areas than radicular pain

Question 22

What are the nerve traction tests used in orthopedic (provocative) testing of the lumbar spine and pelvis?

Answer 22

• straight leg raising
• Braggard’s test
• bow string test

They are often done as a group

Question 23

When performing the straight leg raising test for nerve traction, what does it mean when symptoms are produced or exacerbated between 0-35 degrees?

Answer 23

Extradural sciatic involvement is suspected such as piriformis syndrome because there is no nerve root traction or lumbar joint movement in this range

Question 24

When performing the straight leg raising test for nerve traction, what does it mean when radicular pain into extremities occurs between 35-70 degrees?

Answer 24

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

Question 25

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?

Answer 25

Nerve roots are fully stretched at this pointe to the likely cause of pain is lumbar orthopedic in nature

Question 26

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?

Answer 26

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

Question 27

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?

Answer 27

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

Question 28

What tests can be used as SI/lumbar differential tests?

Answer 28

- Goldthwait’s | - supported forward bending test

Question 29

How would you perform Goldthwait’s test?

Answer 29

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.

Question 30

How would you perform the supported forward bending test?

Answer 30

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

Question 31

When performing Goldthwait’s test, If low back pain is brought on before the lumbar spine begins to move, what is suspected?

Answer 31

an SI lesion is suspected.

Question 32

When performing the supported forward bending test, if low back pain is absent, what is suspect?

Answer 32

an SI lesion is suspected.

Question 33

When performing the supported forward bending test, if low back pain is reproduced or aggravated, what is suspect?

Answer 33

Lumbar lesion suspected

Question 34

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:

Answer 34

- 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

Question 35

How would you perform the Patrick FABER test?

Answer 35

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

Question 36

How would you perform the thigh thrust test?

Answer 36

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.

Question 37

How would you perform Gaenslen’s test?

Answer 37

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

Question 38

How would you perform the sacroiliac stretch test?

Answer 38

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

Question 39

How would you perform the sacroiliac compression test

Answer 39

patient lying on side, Dr. presses downward on | the ilium to compress the SI joint, more posteriorly. pain in SI joint indicates SI lesion

Question 40

How do you preform the sacral thrust?

Answer 40

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.

Question 41

How would you perform HIbb’s test?

Answer 41

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

Question 42

How would you perform Yeoman’s test?

Answer 42

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)