L1 Lumbar Clearing

Question 1

Lumbar Clearing Tree

Answer 1

Negative = proceed with hip exam
Positive = proceed with lumbar scan

Lumbar Scan + = Lumbar Exam
Lumbar Scan – = Hip Exam

Question 2

Hip pain doesn’t refer _____

Answer 2

proximally

but hip dysfunction can contribute to lumbar pain

Question 3

Shared subjective complaints

Answer 3

pain with sitting
pain with sit to stand
pain with walking
pain with sleeping

Question 4

Patients with both hip pain and LBP

Answer 4

have more pain and worse function compared with patients with just LBP

Question 5

MCL tear in the knee creates instability in the ______ plane and might cause ______ at the hip in the ______ plane

Answer 5

frontal
abduction
frontal

Question 6

Limited hip IR ROM creates ____ in the ____ plane at the hip and might cause _____ at the lumbar spine in the _____ plane

Answer 6

decreased mobility
transverse
increased mobility
transverse

Question 7

Clearing the Lumbar Spine means

Answer 7

-brief exam of the LS to rule out involvement that may contribute to lower extremity pain/dysfunction

does not include neuro exam, not a complete lumbar exam, should occur at the beginning of your physical exam

Question 8

Lumbar Clearing Tests

Answer 8

1. Lumbar Flexion, Extension, LF, Extension Quadrant AROM
2. Repeated movements
3. Overpressure

Question 9

Overpressure should not be applied in case of

Answer 9

acute/severe pain OR if AROM and or repeated movements produce S/S

Question 10

You do not need to do repeated movements for

Answer 10

quadrant testing

Question 11

Lumbar Scan Exam

Answer 11

myotomes
dermatomes
DTRs
Babinski
Clonus
Neural Tension

Question 12

L2 myotome

Answer 12

Hip flexion
Femoral, Roots

Question 13

L3 myotome

Answer 13

knee extension
femoral

Question 14

L5-S1 myotome

Answer 14

knee flexion
tibial

Question 15

L4 myotome

Answer 15

ankle DF
deep fibular

Question 16

L5 myotome

Answer 16

great toe extension
deep fibular

Question 17

S1myotome

Answer 17

Ankle Eversion
superficial fibular

Question 18

S2 myotome

Answer 18

Ankle PF
Tibial

Question 19

L2 Dermatome

Answer 19

lateral proximal thigh
lateral femoral cutaneous nerve

Question 20

L3 Dermatome

Answer 20

medial knee
anterior femoral cutaneous nerve

Question 21

L4 Dermatome

Answer 21

medial malleolus
saphenous nerve

Question 22

L5-S1 Dermatome

Answer 22

Dorsum of 3rd MTP
superficial peroneal nerve

Question 23

L5 Dermatome

Answer 23

Webspace between 1st and 2nd MTP
Deep peroneal nerve

Question 24

S1 Dermatome

Answer 24

Lateral heel
Sural nerve

Question 25

S2 Dermatome

Answer 25

Medial posterior knee/thigh
posterior femoral cutaneous nerve

Question 26

Babinski

Answer 26

Normal = toes curl
Present = hallux extends, toes fans out

Question 27

Clonus

Answer 27

Rapid stretch into DF, count the PF beats
0 = no reaction
1 = mild, clonus <3 sex
2 = moderate, clonus 3-10 s
3 = severe, clonus >10 s

Question 28

Straight Leg Raise Test

Answer 28

SN = .92
SP = .28
+LR = 4.2 if acute

Strong correlation between patients with sciatic symptoms and disc herniation and nerve root compression on MRI findings

Question 29

Slump Test

Answer 29

SN = .84-1.0
SP = .70-1.0
+LR = 3.0-11.9

if symptoms decrease with release of neck flexion, this may implicate adverse neural dynamics as possibly source of symptoms

Question 30

When you should refer?

Answer 30

Lumbar clearing positive
Lumbar scan exam positive for myotomal and DTR deficits