Assessment II Quiz I

Question 1

List 5 Questions you might ask in the History section of the assessment for a patient with low back pain complaints.

Answer 1

Reason for seeing you
Describe the specific mechanism of injury
Date of injury
Onset slow or sudden, new, or recurring problem
Diagnosis, who diagnosed condition, how was it diagnosed and when
Treatment sought, type of treatment
Immediate problems or symptoms….part of history
Lost work time
Medications-names, dosages, taken as prescribed, side effects, etc.
Social history
Allergies
General Health
Past Medical History
Sleeping position, types of pillows, mattresses, etc.
Hobbies, recreation
Description of Typical Day

Question 2

If a patient states that sitting, coughing, and sneezing results in leg pain, what structure is likely compressing the nerve root and causing the symptoms?

Answer 2

Disc (protrusion)

Question 3

What are the two types of muscle testing? How are the results recorded for each?

Answer 3

Isometric-strong or weak
Isotonic-graded 0-5

Question 4

What are the two types of range of motion testing that are ways of testing movements passively?

Answer 4

i. Taking the patient’s limb through range of motion without help from the patient
ii. Overpressure

Question 5

Describe the Babinski test and indicate what a positive response means

Answer 5

Patient Position: supine or sitting with the knee straight and supported on the table
Test Action: Examiner stabilizes the tib/fib and draws a fingernail or the end of a hammer from the lateral heel, up the lateral side of the foot and across the ball of the foot to the plantar surface of the first MTP area
Positive Response: big toe extends, and the others abduct
Indicates: UMN Lesion

Question 6

What is a capsular pattern? What is the capsular pattern for the lumbar spine?

Answer 6

A capsular pattern is when there is limitation of movement that is proportional and specific to the joint. The lumbar capsular pattern is side flexion and rotation equally limited, extension (NOT equal but equally limited)

Question 7

If a patient can abduct his hip through partial range against gravity, what grade would you give his abductors?

Answer 7

3-

Question 8

What is the test action for the L3 Myotome?

Answer 8

Knee Extension

Question 9

Where would you lightly brush the skin if you wanted to assess the L4 dermatome

Answer 9

Lateral side of mid to lower posterior thigh, lateral knee, medial anterior shin, medial posterior calf, medial malleolus to anterior big toe

Question 10

What nervous system segments does the achilles reflex test?

Answer 10

S1-S2

Question 11

Define scoliosis? If the convexity is to the left, is this a left or right scoliosis?

Answer 11

A scoliosis is a lateral curvature of the spine. A scoliosis is named for the direction in which the convexity goes. If the convexity is to the left, this a left scoliosis.

Question 12

What is the test action for the L4 myotome?

Answer 12

Big Toe Extension

Question 13

Where would you touch the skin to assess the S1 dermatome?

Answer 13

Lateral border of calf to heel and lateral side of foot to plantar fourth and fifth toes

Question 14

Describe SLR test and indicate the positive response.

Answer 14

Position: supine, relaxed
Test action of examiner: medially rotates and adducts the hip, then passively flexes the hip, keeping the hip medially rotated and adducted and the knee straight, until the patient complains of pain or tightness (end of actual SLR test, but we will continue). The examiner slowly lets the hip extend passively until there is no pain or tightness, then examiner passively dorsiflexes the ankle (Bragard’s Test) or instructs the patient to flex the neck (Brudzinki or Linder Sign), or both, to see if pain returns. Dorsiflexion is usually done first.
Positive response: pain radiates down leg along the affected dermatome(s) on that side (also positive if radiates down other side, but indicates a large central intervertebral disc protrusion in that case)
Indicates: nerve root impingement of L4 -S3 (whichever nerve roots are affected)

Question 15

List two signs or symptoms for acute arthritis of facets.

Answer 15

1) sharp pain on full side flexion and rotation same side, full extension 2) pain usually localized but may radiate to buttock or up spine 3) may have pulling sensation at facet with flexion and side flexion and rotation to opposite side 4) no pain on resisted movements in neutral position 5) tenderness on palpation of facets (spinous and transverse processes) 6) positive Kemp’s Test

Question 16

List two signs or symptoms for nerve root impingement.

Answer 16

1) positive SLR test (if L4-S3 roots affected)
2) positive PKB test (if L2-L4 nerve roots affected)
3) weakness of myotome of affected nerve root
4) paraesthesia of dermatome of affected nerve root
5) may have diminished or absent reflexes of affected nerve root
6) altered posture (side shifted) especially if disc protrusion

Question 17

How would you determine if a patient has Spinal Stenosis or Nerve Root Impingement?

Answer 17

Main way to differentiate:
With Spinal Stenosis, symptoms are aggravated by extension (spinal cord bunches) and relieved by flexion (spinal cord thinner and fits in column better)
With Nerve Root Impingement due to a disc, the opposite is the case. Symptoms are relieved with extension (disc material pushed anteriorly away from nerve root) and aggravated by flexion (compresses disc and pushes disc material posteriorly towards nerve root)
Another helpful way to differentiate:
Walking will bother both conditions, but is classic that with stenosis, if the person rests (even just in standing) for a few minutes, the symptoms will usually reduce, and they can walk again. Walking actually involves less disc pressure than standing so standing may be more painful for disc protrusion than walking.

Question 18

Ms. Smith has a decreased patellar reflex, numbness in her buttock, anterior and medial side of her knee, upper medial shin and medial posterior thigh, and weakness of quadriceps. What nerve root is affected?

Answer 18

L3

Question 19

What two position could you use to test hip flexion if a patient has a grade of 3+

Answer 19

i. Standing
ii. Supine (works because you are applying slight resistance throughout so if gravity helps part of the movement it really does not matter)
iii. (As “one” position)
Combination of supine, and get last bit of range with sitting

Question 20

What spinal segments supply bowel and bladder motor function and what single nerve root appears to be most significant for bowel and bladder?

Answer 20

Motor Function S2-S4; Most likely S3 (Sensory is S3-S5 saddle region)

Question 21

Ms. Jones has an L5 nerve root impingement. Indicate the following: Area of skin affected (whole dermatome), test action (myotome) affected, reflexes that may be affected, and two special tests that would likely be positive.

Answer 21

Area of skin: small strip from knee to lateral upper calf, top of foot (toes two to four) and undersurface of big toe, second, and third toes.
Test action: big toe extension
Reflexes: medial hamstring, tibialis posterior
Special tests: SLR, slump, Valsalva (NOT PKB BECAUSE THAT IS FOR L2-L4)

Question 22

Mr. Smith has weakness of ankle dorsiflexion, numbness along the medial side of his calf, ankle and foot and a diminished quadriceps reflex. What nerve root is likely affected and name four special tests that would likely be positive?

Answer 22

L4: SLR, PKB, Valsalva, Slump (and Gaenslen’s which we take under pelvis section)

Question 23

For the prone knee bend test, indicate the following: patient position, test action of examiner, positive responses, what positive responses indicate.

Answer 23

Patient position: prone
Test action: examiner passively flexes the patient’s knee, taking the heel towards the buttock and holds 45 seconds
Positive response: pain in the lower back and/or L2 or L3 or L4 dermatome, or along femoral nerve distribution
Indicates: L2 or L3 or L4 nerve root impingement or femoral nerve irritation

Question 24

If the patient cannot fully flex the knee in the prone knee bend test, what adaptations should the examiner make to perform the test?

Answer 24

i. flex the patient’s knee as far as comfortably possible
ii. then passively extend the hip, stabilizing the pelvis. Still hold for 45 seconds

Question 25

Complete the following sentences. Dural stretch occurs between _________ degrees of knee flexion in the prone knee bend test (PKB). Dural stretch starts at
__ degrees and ends at approximately _0 degrees during the straight leg raise (SLR).

Answer 25

80 and 100 degrees; 35 degrees; 70 degrees

Question 26

Indicate what needs to be ruled out in the SLR and PKB tests.

Answer 26

SLR-rule out hamstring pain/tightness and SI joint pathology
PKB-rule out rectus femoris tightness and SI joint pathology

Question 27

Define lordosis.

Answer 27

Anterior curvature of the spine.

Question 28

A patient has a structural scoliosis. What will the examiner notice when the patient flexes the spine?

Answer 28

With scoliosis, have patient flex in standing. If scoliosis is non-structural, the scoliotic curve will disappear on flexion. If it is structural, there will be a hump on the convex side of the curve and a hollow on the other side. The hump is visible due to rotation of vertebrae which pushes ribs and muscles out on the convex side.

Question 29

Define gibbus deformity.

Answer 29

Sharp, angulated, local kyphosis (can be anywhere in the spine)

Question 30

Define the effect of flexion on pain in spinal stenosis versus lumbar disc protrusion and indicate the reason for pain aggravation or relief in each case.

Answer 30

Flexion will reduce pain in spinal stenosis because the cord stretches, becoming narrower and fits in canal with less pressure. Flexion will increase pain from a lumbar disc location, causing pressure on the nerve roots.

Question 31

A patient has an increased lumbar lordosis. Name two different structures that could be aggravated.

Answer 31

Anterior longitudinal ligament
Facet joints

Question 32

List four fill-ins

Answer 32

Goniometry/tape measure
Passive extension of the spine in prone
Isometric thoracic/lumbar movements
Isotonic thoracic/lumbar movements (usually avoided)
Local ST, SP, and temperature testing

Question 33

What is the purpose of the lumbar scan?

Answer 33

To determine if the symptoms the patient is experiencing are due to pathology in the lumbar spine, peripheral (lower extremity) joints, or pathology in both areas.

Question 34

What is the landmarking for measuring spinal flexion?

Answer 34

If whole spine-C7 and S1
If thoracic only-C7 and T12
If lumbar only-T12 and S1

Question 35

How are the peripheral joints evaluated in the lumbar scan?

Answer 35

i. PSIS or Gillet’s AND Sacral Sulcus
ii. Squat or testing active movements of each joint individually

Question 36

Excluding the pelvis, indicate the two ways of testing the peripheral joints in the lumbar scan.

Answer 36

i. squat
ii. active ROM of each join/movement individually

Question 37

In #36, one method is quicker than the other. Indicate the quicker movement and give 3 instances when you would not use the quicker method.

Answer 37

Squat is the quicker method
Not used if: later pregnancy, poor balance, elderly, obvious lower extremity joint problems

Question 38

Define spondylolisthesis, indicate the number of grades of spondylolisthesis and give two signs/ symptoms of a grade of III.

Answer 38

Definition: bilateral defect of pars interarticularis with forward slippage of a vertebral body and its transverse processes on vertebra below
Grades: slippage classified from grade I to IV (so IV grades)
S/S of grade III: localized radiating pain and paresthesia along dermatomes (multiple dermatomes/nerve roots), functional impairment, bowel and bladder problems