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MSK 2 > L/S Examination > Flashcards

L/S Examination Flashcards

1
Q

list red flags that are commonly listed in research

A
  1. age > 50 yrs
  2. no improvements in symptoms after one month
  3. insidious onset
  4. a previous history of cancer
  5. no relief with bed rest
  6. unexplained weight loss
  7. fever
  8. T/S pain
  9. being systematically unwell
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2
Q

list common functional limitations surrounding L/S

A
  1. lifting
  2. bending
    • dressing
  3. squatting
  4. twisting at trunk (i.e reaching in back seat of car)
  5. extension activities (i.e reaching on overhead shelf)
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3
Q

list outcome measures for lower back

A
  1. patient specific functional scale (PSFS)
  2. Oswestry Disability Index (ODI)
  3. Roland Morris Questionnaire
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4
Q

list outcome measures for psychosocial

A
  1. fear avoidance beliefs questionnaire (FABQ)
  2. pain catastrophizing scale (PCS)
  3. tampa scale of kinesiophobia (TSK)
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5
Q

what should be included in the visual inspection in the anterior view?

A
  1. visual inspection
    • weight shifting
    • pelvic asymmetry
    • LE alignment
    • Distress
  2. Posture examination w/landmark palpation
    • ASIS
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6
Q

what should be included in the visual inspection in the posterior view?

A
  1. Visual inspection
    • soft tissue and bony contour general symmetry
      • especially erector spinae mass
      • scapulae: inferior angles in line with spinous process T7
      • tibial and fibular malleoli
      • popliteal crease
  2. posture assessment w/landmark palpation
    • vertical alignment of spine
    • Iliac crest height
    • PSIS
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7
Q

what common abnormalities should be assessed for in the posterior view?

A
  1. Lateral shift → lumbar lateral flexion with compensatory upper lumbar/thoracic contralateral flexion
    • often attributed to lumbar lateral flexion “away” from laterality of pain source
    • commonly correlated with posteriolateral disc bulge, unilateral facet arthropathy
  2. Scoilotic curve
  3. Unilateral muscle mass variance
    • morphologic → atrophy (erector spinae, gluts)
    • physiologic → guarding, inhibition, spasm, volitional
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8
Q

what are you looking for in the lateral view during the visual inspection?

A
  1. Visual inspection
    • “plumb line” assessment
    • external auditory meatus, acromion, peak of iliac crest
    • lordotic curvature (excessive vs. diminished)
  2. Posture assessment w/landmark palpation
    • vertical alignment of spine
    • iliac crest height
    • PSISs
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9
Q

what are some common abnormalities you should be viewing in the lateral view?

A
  1. excessive lumbar lordosis
    • tripod effect → z-joints become weight bearing
    • may accompany anterior pelvic tilt
  2. diminished lumbar lordosis
    • flat back posture
    • may be consistent with lumbar stenosis
  3. sway back posture
    • excessive thoracic kyphosis and posterior pelvic tilt
    • excessive hip extension
    • lengthened back extensors and hip flexors
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10
Q

during a gait analysis what should be looked for in the anterior/posterior view?

A
  1. lumbar rotation
    • excessive, may be compensatory and related to LE limitations
    • limited may implacte muscle guarding or avoidance
  2. lumbar lateral flexion
    • corrective strategy to shift weight
  3. hip adduction
  4. hip rotation (may observe better w/knee in respect to distance from midline)
  5. excessive ankle inverions/eversion
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11
Q

what gait deviations may be observed in the lateral view?

A
  1. slouched gait
  2. hip extension
  3. knee flexion/extension
  4. tibial advancement
  5. ground striking and related observations
    • contacting ground w/flat foot or toe
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12
Q

List elimination tests utilized in a lumbar exam

A
  1. Lower Quarter Screen (LQS)
  2. Neuro Screening tests
    • sensation
    • motor function
    • DTR
  3. Special tests
    • slump test
    • straight leg raise test
    • extension rotation test
    • lumbar stenosis clincial prediction rule
    • lumbar percussion
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13
Q

what is included in the lower quarter screen?

A
  1. Lumbar AROM
  2. Squat
  3. Unilateral squat vs modified lunges
  4. Walking on heels
  5. Walking on toes
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14
Q

what is included in sensation testing?

A
  1. light touch
  2. pin prick
  3. proprioception

findings reported as symmetrical, normal/diminished, absent

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15
Q

what is included in testing motor function (for neurological tests)

A
  1. myotome
  2. peripheral nerve distribution
  3. coordination

findings reported as symmetrical, normal/diminished/absent

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16
Q

Nerve root L1

A
  1. sensory testing → proximal anterior thigh
  2. myotome testing → hip flexion
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17
Q

Nerve root L2

A
  1. sensory testing → middle, anterior thigh
  2. myotome testing → hip flexion
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18
Q

Nerve root L3

A
  1. Sensory testing → medial knee
  2. Myotome testing → knee extension
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19
Q

Nerve root L4

A
  1. Sensory testing → medial foot
  2. Myotome testing → ankle dorsiflexion
  3. DTR → quads
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20
Q

Nerve root L5

A
  1. Sensory testing → dorsum of foot
  2. Myotome testing → great toe extension
  3. DTR → extensor digitorum brevis
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21
Q

Nerve root S1

A
  1. Sensory Testing → lateral foot and 5th toe
  2. Myotome testing → ankle plantarflexion
  3. DTR → achilles
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22
Q

Nerve root S2

A
  1. Sensory testing → medial posterior leg
  2. Myotome testing → knee flexion
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23
Q

what elimination tests are for lumbar spine radiculopathies

A
  1. The Slump Test
  2. The Straight Leg Raise Test
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24
Q

what elimination tests are for Z-joint pain?

A

the extension rotation test

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25
Q

what elimination tests are for lumbar stenosis?

A

clinical prediction rule

26
Q

what elimination tests are for compression fractures?

A

lumbar percussion

27
Q

describe the research properiteis and clinical implications for the slump test?

A
  1. research properties
    • +LR → 1.82
    • -LR → 0.32
  2. clinical implications
    • utility for screening and/or validation of hypothesis
    • limited evidence
28
Q

describe the research properities and clinical properties of the straight leg raise test

A
  1. Research Properties
    • +LR → 2.23
    • -LR → 0.05
  2. Clinical Implications
    • many studies of lesser quality support sensitivity of test
29
Q

list the potential for sensitizing during the SLR Test

A
  1. Cervical flexion
  2. Hip IR
  3. Hip Adduction
  4. Ankle DF
  5. Ankle DF and Inversion → sural nerve bias
  6. Plantarflexion and Inversion → fibular nerve bias
30
Q

describe the research properties and clinical implications for the extension-rotation test

A
  1. Research properties
    • +LR → 1.13-1.28
    • -LR → 0.00
  2. Clinical implications
    • great screening test for z-joint pain; not good for validating hypothesis
    • many structures are stressed; unlikely to specifically implicate arthrogenic pain
31
Q

what items are included in the clinical prediction rule for lumbar stenosis?

A
  1. bilteral symptoms
  2. leg pain > back pain
  3. pain with walking/standing
  4. pain relieved with sitting
  5. age > 48 years
32
Q

describe the research properties and clinical implications for the CPR for lumbar stenosis

A
  1. Research properties
    • 0 items present: -LR → 0.19
    • 4 or 5 items present: +LR → 4.6
  2. Clinical implications
    • good screening tool, though relies on subjective history
    • retrospective analysis on large population
33
Q

describe the research properties and clinical implications of the percussion test

A
  1. Research properties
    • +LR → 8.8
    • -LR → 0.14
  2. Clinical Implications
    • use cautiously if fracture is suspected
34
Q

during AROM, how much flexion observed is truly from the lumbar spine?

A

~first 60 or so should be lumbar

35
Q

how can you report flexion AROM results in the quartile percentages?

A

observe fingertips reach to:

  • 25% → mid-thigh
  • 50% → knees
  • 75% → mid-lower leg
  • 100% → feet/floor
36
Q

where is overpressure applied during lumbar flexion AROM?

A

face pt’s side (slightly anterior), apply pressure from:

  • mid-thoracic area of anterior side
  • superior sacral area/lower lumbar area
37
Q

what is Gower’s sign?

A

a compensatory movement with returning from flexion

walking hands up LEs to return to upright position

38
Q

where is overpressure applied during lumbar AROM extension?

A

face pt’s side (slightly behind), place UE across upper chest (level of manubrium) and hand resting on contralateral shoulder, apply pressure from

  • anterior chest or anterior side
  • stabilize w/other hand at superior sacral area/lower lumbar area
39
Q

where is overpressure applied during lumbar lateral flexion AROM?

A

Overpressure → from behind pt (to side of lateral flexion), apply pressure from:

  • lateral iliac crest of ipsilateral side
  • proximal lateral upper arm of contralateral side
40
Q

where is overpressure applied during axial rotation during lumbar AROM?

A

face pt, block knee and apply pressure from

  • anteriolateral proximal upper arm of ipsilateral side
  • upper scapula of contralateral side
41
Q

what combined motions are tested during lumbar structural stress testing?

A
  1. flexion, rotation, contralateral lateral flexion
  2. extension, rotation, ipsilateral lateral flexion
42
Q

what is included with structural stress testing PROM?

A
  1. Sitting Exam
    • flexion
    • extension
    • lateral flexion
    • rotation
  2. Alternatives
    • flexion → quadruped or DKTC (double knees to chest)
    • prone press-up (extension)
43
Q

how to perform PROM sitting assessment

A
  • Pt sitting at corner of table with arms across chest
    • pt’s hips and knees at right angles, trunk upright
    • feet flat on floor (or stable surface, such as a box step)
  • Be sure to support trunk well and ensure pt’s trunk is relaxed
    • facing pt’s side, reach your UE under the contralateral forearm such that your forearm is resting over the pt’s ipsilateral forearm and your hand is resting on the latereal contralateral shoulder
44
Q

List bone and joint structures that should be included in palpation during a L/S exam

A
  1. Spinous processes
    • step-off deformity → notable difference in segemental prominence of spinous process
      • may indicate serious injury spondylolysthesis, compression frx
    • vertical alignment → rotational abnormality
  2. Transverse processes
  3. PSIS
  4. ASIS
  5. Symphysis Pubis
45
Q

list soft tissue structures that should be included in palpation during L/S exam

A
  1. Erector Spinae
  2. Iliolumbar Ligament
  3. Glut max muscle belly
    • especially if pain referred in buttock area
    • excessive tugor may indicate guarding related to rotation of pelvis
  4. Glut med muscle belly and insertion site
    • especially if pain referred in buttock area
  5. Area between ASIS and Symphysis Pubis
    • may observe tenderness w/hernia, abscess, infection (lymph nodes)
46
Q

Manual Assessment L/S exam

A
  1. Assessing for
    • gross quantity of movement
    • end-feel (quality of movement)
    • provocation
  2. Translatoric Joint Play Movements
    • Traction → separation of joint surfaces with force direction perpendicular to joint plane
    • Compression → approximation of joint surface with force direction perpendicular to joint plane
    • Gliding → force direction parallel to joint surface
47
Q

Joint Mobility Thoracolumbar Spine

A
  1. PAIVM
    • Lumbar
      • CPA
      • UPA
  2. PPIVM
    • Lumbar
      • flexion
      • extension
      • rotation
      • lateral flexion
48
Q

List confirmation tests for L/S exam

A
  1. Discogenic symptoms
    • centralization w/repeated motions
  2. HNP/Lumbar Radiculopathy
    • well leg raise test
    • femoral nerve tension test
    • CPA/Spring Testing
  3. Instability
    • Catch sign
    • Passive Lumbar Extension Test
    • Prone Instability Test
49
Q

describe positive tests, research properites, and clinical implications for Centralization

A
  1. Positive Tests
    • centralization (or peripheralization) of symptoms
  2. Research Properties
    • +LR → 6.7 to 2.6
    • -LR → 2.6 to 0.12
  3. Clinical Implications
    • likely better utility for validating hypothesis
    • required for “centralization classifcation” of TBC
    • Note nerve root vs zygapophysial distrubtion
50
Q

describe positive tests, research properties, and clinical implications for the Well Leg Raise Test

A
  1. Positive Test
    • concordant pain provocation (LE contralateral to the one that is raised)
  2. Research Properties
    • +LR → 1.91 to 14.3
    • -LR → 0.59 → 0.86
  3. Clinical Implications
    • likely better utility for validating hypothesis
    • not good screening utility
51
Q

describe research properties, and clincial implications for the Femoral Nerve Tension Test

A
  1. Research properties
    • no known studies with QUADAS scores >/= 10
  2. Clinical Implications
    • be sure to monitor for symptoms at each composite motion and throughout composite motions
    • Instruct pt thoroughy prior to the test
52
Q

describe positive tests, research properties, and clinical implications for CPA (spring testing)

A
  1. Positive Test
    • concordant symptom provocation (local, radicular); linear displacement during exam procedure
  2. Research Properties
    • +LR → 2.26 to 8.6
    • -LR → 0.6 to 0.79
  3. Clinical Implications
    • also described as the passive accesory joint mobiility test
53
Q

describe the research properties and clinical implications for the Instability Catch Sign

A
  1. Research Properties
    • +LR → 1.57
    • -LR → 0.31
  2. Clinical Implications
    • may aid in ID pt in specific exercise category
54
Q

describe the research properties and clinical implications for the passive lumbar extension test

A
  1. Research Properties
    • +LR → 8.78
    • -LR → 0.17
  2. Clinical Implications
    • single study
    • monitor symptoms closely throughout procedure
55
Q

describe the research properties and clinical implications for the prone instability test

A
  1. Research properties
    • +LR → 1.41
    • -LR → 0.69
  2. clinical implications
    • component of TBC
56
Q

List several performance measures that can be included in the L/S exam

A
  1. Activation of the TrA and multifidus
    • check coordination
    • utilize palpation or ultrasound imagining
    • can test and use as intervention (biofeedback or coordination)
57
Q

describe the set up for multifidus activation testing

A
  1. pt position
    • side-lying, support under area from lower rib to iliac crest as needed
    • alternative position in prone (be careful to avoid lumbar extension and thus erector spinae activation)
  2. examiner position
    • standing facing pt’s anterior
58
Q

what substitutions should you monitor for during TrA activation testing?

A
  1. holding breath/Valsalva’s maneuver
  2. active lumbar motion (pelvic tilting)
  3. quick contraction
  4. IO activation
59
Q

describe the set up for TrA activation testing

A
  1. Pt positioning → hook lying
  2. examiner positioning → standing, facing pt
  3. procedure
    • palpate ~1 inch medial to ASIS (closest to examiner)
    • palpate for activation of musculature
    • compare bilaterally
    • avoid valsalva
60
Q

List methods to test TrA

A
  1. Pressure Biofeedback test
    • stabilizer cuff posterior to L/S centered at L3 and inflated to 40 mmHg
    • pt performs draw in maneuer and holds 10 seconds
    • monitor for ability to maintain pressure within 5degree of baseline
  2. Prone drawing test
    • pt in prone position w/stabilizer cuff anerior margin of lower abdomen and inflated to 70 mmHg
    • normal value = pressure decrease in >/= 4 mmHg
    • decrease in pressure = 2 mmHg → impaired muscle function

MSK 2 (20 decks)

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