4: Clinical Lumbar

Question 1

What is the first ligament to become tender with postural changes?

Answer 1

Iliolumbar

Question 2

What ligament runs from the base of the occiput to the ANTERIOR sacrum?

Answer 2

ALL

Question 3

Which ligament narrows as it descends?

Answer 3

PLL

Question 4

How do you test for psoas spasm/tightness?

Answer 4

Thomas test

Question 5

A straight leg raise of what degree indicates a sciatic problem?

Answer 5

35-70

Question 6

A straight leg raise of greater than 70 degrees indicates what kind of problem?

Answer 6

Hip or joint

Question 7

If a pt has dysfunction, when they raise one leg they should be creating pressure on the contralateral leg. If not, what’s happening? What’s this test called?

Answer 7

Malingering; Hoover test

Question 8

What test indicates a weak gluteus medius?

Answer 8

Trendelenberg

Question 9

What test will increase pain/Sx of a disc herniation?

Answer 9

Valsalva maneuver

Question 10

What are the #1 and #2 most common areas for lumbar disc her nation?`

Answer 10

#1 L5-S1
#2 L4-5

Question 11

What is the pathogenesis of disc herniation?

Answer 11

Narrowing of PLL

Question 12

What are the Sx of disc herniation?

Answer 12

Sharp low back pain
Radioculopathy in LEs (worse with Valsalva)
Motor sensory deficits possible

Question 13

How do you name lumbar disc?

Answer 13

Named for the vertebra above it

Vertebra sits on its on disc ‘throne’ of same name

Question 14

Herniation of a disc affect what nerve root?

Answer 14

The one below!

Question 15

L4 reflex

Answer 15

Patellar reflex

Question 16

L4 motor innervation

Answer 16

Ant tibialis (inversion + dorsiflexion of foot)
Quads (extension)

Question 17

L4 Sensory innervation

Answer 17

Medial leg + foot

Question 18

L5 motor innervation

Answer 18

Extensor hallicus longus (dorsiflexion of big toe)

Question 19

L5 sensory innervation

Answer 19

Lateral leg + dorsum of foot

Question 20

S1 reflex

Answer 20

Achilles reflex

Question 21

S1 motor innervation

Answer 21

fibularis longus + brevis (everstion and plantarflexion)

Question 22

S1 sensory innervation

Answer 22

Lateral foot

Question 23

Iliopsoas innervation

Answer 23

T12; L1-3

Question 24

Quadriceps innervation

Answer 24

Femoral nerve

Question 25

Hip adductor group innervation

Answer 25

Obturator (L2-4)

Question 26

Tibialis Ant. innervation

Answer 26

Deep fibular n. (L4) | Dorsiflexion + Inversion

Question 27

What would cause aching low back pain to lower legs that is worsened with extension and relieved by sitting?

Answer 27

Spinal stenosis

Question 28

What muscle is hypotonic in spinal stenosis?

Answer 28

Anal sphincter

Question 29

What would you see on Xray with spinal stenosis?

Answer 29

Osteophytes

Question 30

What would cause peripheral neuritis of the sciatic nerve?

Answer 30

Piriformis syndrome

Question 31

What could be caused by things like prolonged flexion, appendicitis, calculi, or salpingitis?

Answer 31

Psoas syndrome

Question 32

Which levels might be hyper flexed or extended in Psoas syndrome?

Answer 32

L1-2

Question 33

On what side are you going to have a positive pelvic shift test or a piriformis spasm with Psoas syndrome?

Answer 33

Contralateral side

Question 34

Sudden onset, severe low back pain without prior Hx could indicate what?

Answer 34

Dissecting aortic aneurysm

Question 35

Claudication Sx with back pain indicates what disease?

Answer 35

Spinal stenosis

Question 36

What could be indicated if a pt has pain that wakes them from sleep?

Answer 36

Malignancy

Question 37

Rapidly progressing neurological deficits could indicate what problem?

Answer 37

Epidural abscess or infection

Question 38

Spondylosis generally indicates what?

Answer 38

Degenerative changes

Question 39

A defect of the pars WITHOUT anterior displacement is known as what?

Answer 39

Spondylolysis

Question 40

How is a Dx of spondylolysis made?

Answer 40

Oblique XR

Question 41

Spondylolisthesis most commonly occurs where?

Answer 41

L5 on S1

Question 42

Grade I Spondylolisthesis

Answer 42

0-25% displacement

Question 43

Grade II Spondylolisthesis

Answer 43

25-50%

Question 44

Grade III Spondylolisthesis

Answer 44

50-75%

Question 45

Grade IV Spondylolisthesis

Answer 45

>75%

Question 46

What is Tx contraindicated for Spondylolisthesis?

Answer 46

HVLA