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CONA 1 > Lab Procedures > Flashcards

Lab Procedures Flashcards

1
Q

In order to perform the STRAIGHT LEG RAISE examination:

  • patient supine
  • zero out inclinometer on tibial tuberosity
  • raise leg to 90* or point of pain
  • Bilaterally, Uninvolved leg first

-List Positive findings and Indications:

A

Positive findings- posterior leg pain/ radicular pain

Indications-
0-35*- SI disorder, Muscle dysfunction, piriformis syndrome

35-70*- radiating pain suggests Disc pathology (extrusion), osteophyte, hemangioma (tumor) ** affects L5, S1, S2 nerve roots**

70-90*- Local lumbar pain= lumbar joint disorder (sublaxation), dull posterior leg pain = tight hamstring

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2
Q

BRAGARD’S TEST:

  • Patient is supine
  • make sure patient tells you if symptoms are reproduced
  • zero inclinometer on tibial tuberosity
  • flex hip with knee extended to point of pain
  • back off 5* and dorsiflex foot
  • Bilaterally, uninvolved leg first

-List Positive findings and Indications:

A

Positive findings-reproduction of posterior leg pain with dorsiflexion of foot

Indications-
0-35*- SI disorder, Muscle dysfunction, piriformis syndrome

35-70*- radiating pain suggests Disc pathology (extrusion), osteophyte, hemangioma (tumor) ** affects L5, S1, S2 nerve roots**

70-90*- Local lumbar pain= lumbar joint disorder (sublaxation), dull posterior leg pain = tight hamstring

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3
Q

SICARD’S TEST

  • Patient is supine
  • make sure patient tells you if symptoms are reproduced
  • zero inclinometer on tibial tuberosity
  • flex hip with knee extended to point of pain
  • back off 5* and dorsiflex Great toe
  • Bilaterally, uninvolved leg first

-List Positive findings and Indications:

A

Positive findings-reproduction of posterior leg pain with dorsiflexion of Great toe

Indications-
0-35*- SI disorder, Muscle dysfunction, piriformis syndrome

35-70*- radiating pain suggests Disc pathology (extrusion), osteophyte, hemangioma (tumor) ** affects L5, S1, S2 nerve roots**

70-90*- Local lumbar pain= lumbar joint disorder (sublaxation), dull posterior leg pain = tight hamstring

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4
Q

LASAGUE’S TEST:

  • Patient is supine
  • make sure patient tells you if symptoms are reproduced
  • perform a straight leg raise to the point of Pain
  • flex the knee to see if pain goes away, then extend knee to see if pain returns (keep hip flexed)
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings-Posterior leg pain/ radicular pain when hip is flexed and knee is in extension and no pain when hip is flexed and knee is also in flexion

Indications- lumbar nerve root compression/ irritation, lumbar radiculopathy

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5
Q

BOWSTRING SIGN:

  • patient is supine
  • make sure patient tells you if symptoms are reproduced
  • perform a straight leg raise till point of pain
  • Flex at knee and support leg with shoulder
  • exert pressure on thigh, if no pain exert pressure in the poplitieal fossa
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings- reduction of pain with knee flexion, posterior leg pain/ radiculopathy (increased) with pressure in popliteal fossa

Indications- lumbar nerve root compression/ irritation

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6
Q

SCIATIC TENSION TEST:

  • Patient is seated
  • make sure patient tells you if symptoms are reproduced
  • passively extend patients leg to point of pain
  • lower the leg back down just below point of pain
  • place leg between dr’s knees and apply P-> A pressure in popliteal fossa
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings- reduction in pain when leg is lowered and radicular pain when pressure is applied

Indications- intradural or extradural irritation of the sciatic nerve

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7
Q

BECHTEREW’S TEST:

  • patient is seated
  • make sure patient tells you if symptoms are reproduced
  • instruct patient to actively raise each leg concurrently
  • if no pain have patient raise both legs simultaneously
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings-inability to perform test due to radicular pain or performs test but leans back

Indications- intradural or extradural compression of the sciatic nerve or lumbar nerve roots

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8
Q

TRIPOD SIGN:

  • patient is seated
  • passivley extend one leg at a time
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings- patient leans back

Indications- tight hamstrings, lumbar nerve root irritation, stretching of the sciatic nerve or meningeal irritation

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9
Q

MINOR’S SIGN:

  • Instruct seated patient to stand up

List Positive findings and Indications:

A

Positive findings- Patient with lumbar radiculopathy will stand on healthy side (lean on healthy side) and keep affected leg flexed to decrease tension on the sciatic nerve, to relieve pain

Indications- Lumbar radiculopthy

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10
Q

ANTALGIC LEAN SIGN:

-Doctor has patient stand and observes

List Positive findings and Indications:

A

Positive findings/Indications-
- Lateral disc herniation- leans away from pain

  • Medial disc herniation- leans towards pain
  • Central disc herniation- may assume a flexed posture
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11
Q

NERI SIGN (NERI BOWSTRING):

  • instruct standing patient to bend at the waist

List Positive findings and Indications:

A

Positive findings- sign is present when affected side knee bends with instructed motion

Indications- lower lumbar nerve root irritation, disc problem or L/S or S/I sublaxation

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12
Q

WELL LEG RAISE TEST:

  • patient is supine
  • make sure patient tells you if symptoms are reproduced
  • raise patient unaffected leg
  • do NOT perform bilaterally

List Positive findings and Indications:

A

Positive findings- posterior leg pain is reproduced on affected leg. (not the one being raised)

Indications- medial disc herniation, lateral disc herniation = less pain on affected side

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13
Q

SLUMP TEST

  • Patient is seated
  • make sure patient tells you if symptoms are reproduced
  • pt. slumps forward
  • support chin
  • overpressure to shoulders
  • tuck chin to chest
  • overpressure to c/s
  • ask pt to straighten one leg at a time and then both
    • if positive findings at any phase, STOP

List Positive findings and Indications:

A

Positive findings- pain at any phase, inability to extend the knee, if pain is relieved with cervical flexion

Indications- meningeal tract irritation due to disc defect, lumbar nerve root or sciatic nerve irritation/ inflamation

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14
Q

KEMP’S TEST

  • patient is seated
  • make sure patient tells you if symptoms are reproduced
  • stabilize PSIS
  • other hand grabs shoulder and passively bends spine obliquely backwards
  • Bilaterally performed

List Positive findings and Indications:

A

Positive findings- radicular pain or localized lumbar pain

Indications- radicular pain = irritation of spinal nerve roots; lateral disc herniation = radicular pain with IPSI bending; medial disc protrusion = radicular pain with CONTRA bending

-local achy pain may indicate facet problems, capsulitis, SI joint problem, muscle spasms

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15
Q

FEMORAL NERVE TRACTION

  • pt is side lying with involved side UP
  • make sure patient tells you if symptoms are reproduced
  • flex the bottom leg at knee and hip
  • grab affected leg and extend hip15* with knee extended
  • flex the knee
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings- pain radiating in to anterior medial thigh; pain extending to mid tibia; contralateral pain

Indications-
pain radiating in to anterior medial thigh- L3 nerve root problem
pain extending to mid tibia- L4 nerve root problem
contralateral pain- nerve root compression or irritation on the opposite side

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16
Q

NACHLA’S TEST

  • pt is prone
  • make sure patient tells you if symptoms are reproduced
  • passivley flex pt’s heel to their butt on IPSI side
  • Bilaterally, uninvolved leg first

List Positive findings and Indications:

A

Positive findings- radicular pain in anterior thigh; local pain in the gluteals or lumbosacral region

Indications- intra/ extradural irritation of fempral nerve roots (piriformis hypertrophy); compression / irritation of L2-4 nerve roots, local pain = SI joint or L/S lesion

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17
Q

VALSALVA’S MANEUVER

  • pt is seated
  • -make sure patient tells you if symptoms are reproduced
  • take a breathe and bear down as if straining to make a bowel movement
  • if pain is elicited, where?

List Positive findings and Indications:

A

Positive findings- pt feels increase in pain

Indications- local pain = disc, mass or osteophyte (SOL in lumbar canal or foramen)

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18
Q

DEJERINE’S TRIAD

  • pt seated
  • make sure patient tells you if symptoms are reproduced
  • cough, sneeze and valsalva’s
  • if pain is elicited, where is it?

List Positive findings and Indications:

A

Positive findings- pt feels increase in pain with any or all actions

Indications- disc, mass or osteophyte

19
Q

MILGRAM’S TEST

  • pt is supine
  • -make sure patient tells you if symptoms are reproduced
  • pt lifts leges 2-3 inches off table and hold

List Positive findings and Indications:

A

Positive findings- unable to perform for 30 sec. without LBP or unable to perform

Indications- pain= disc, mass, osteophyte (SOL inside or ouside spinal canal); and/or weak abdominals

20
Q

NAFFZIGGER’S TEST

  • supine
  • make sure patient tells you if symptoms are reproduced
  • compress the jugular veins for 1min.

List Positive findings and Indications:

A

Positive findings- radicular pain

Indications- pain in lumbar suggests SOL (disc herniation- protrusion or prolapse), may have nerve root involvment

21
Q

LINDNER’S SIGN

  • pt is supine
  • make sure patient tells you if symptoms are reproduced
  • passivley flex the pt’s head

List Positive findings and Indications:

A

Positive findings- radicular pain or hip flexion

Indications- reproduction of pain = disc lesion at the level of pain/ shar or diffuse pain with involuntary hip flexion = meningeal irritation

22
Q

BRUDZINSKI’S SIGN

  • pt is supine
  • make sure patient tells you if symptoms are reproduced
  • passivley flex chin to chest

List Positive findings and Indications:

A

Positive findings- knees bend

Indications- meningeal irritation, radicular pain with lumbar radiculopathy,bacterial meningitis (pt might have head pain/ neck stiffness and elevated temp.)

23
Q

KERNING’S TEST

-pt is supine
-make sure patient tells you if symptoms are reproduced
have pt flex hip and knee to 90 while other leg stays parallel to table
-then have pt extend knee
- bilateral, uninvolved first

List Positive findings and Indications:

A

Positive findings- inability to straighten leg or pain when straightening

Indications- meningeal irritation, meningitis, nerve root involved, disc, tumor, radicular pain

24
Q

GOLDWAITH’S TEST

  • pt is supine
  • make sure patient tells you if symptoms are reproduced
  • dr place 1 hand under pt with fingers in interspinous spaces
  • with other hand perform SLR
  • bilateral, unaffected side first

List Positive findings and Indications:

A

Positive findings- radicular pain before or durring the sp’s fanning out; local pain after sp’s fan out

Indications-
before fan-SI disorder, pirriformis dysfunction (0-35*)

during fan- SOL= disc or osteophyte (35-70*)

after fan- lumbar muscle, ligament or joint disorder

other pains-(hamstring or sublaxation)

25
Q

SIGN OF THE BUTTOCK TEST

  • pt is supine
  • make sure patient tells you if symptoms are reproduced
  • passive SLR
  • if restriction found dr flexes pt’s knee, see if hip flexion increases
  • bilateral, unaffected side first

List Positive findings and Indications:

A

Positive findings- hip flexion does not increase= SI joint dysfunction

Indications- pathology of SI joint or buttocks inflamatory process, bursitis…

26
Q

SUPPORTED FORWARD BENDING TEST

  • pt is standing
  • make sure patient tells you if symptoms are reproduced
  • bend forward, keep knees straight
  • do it again but dr suppot illeum and brace pts sacrum with your hip

List Positive findings and Indications:

A

Positive findings- relief of pain with supported flexion (pain in both = lumbar lesion)

Indications- SI lesion; a lumbar lesion will elicit pain in both instances

27
Q

HIBB’S TEST

  • pt is prone
  • make sure patient tells you if symptoms are reproduced
  • flex pt’s leg to buttock
  • dr moves leg outward, internally rotating hip
  • bilateral, unaffected side first

List Positive findings and Indications:

A

Positive findings- pain in SI or hip joint

Indications- abcess/ sprain of SI; hip joint lesion

28
Q

YEOMAN’S TEST

  • pt is prone
  • make sure patient tells you if symptoms are reproduced
  • dr grabs under one knee while other hand supports si joint
  • extend hip with pressure on SI
  • bilateral, uninvolved first

List Positive findings and Indications:

A

Positive findings- SI or lumbar pain

Indications- Si inflamation, infection, sprain to ant. SI ligaments

29
Q

FLAMINGO TEST

-pt hops around on one foot
-bilateral, uninvolved first
List Positive findings and Indications:

A

Positive findings- increased pain in hip, SI or symphysis pubis

Indications- inflamatory process on the leg theyre standing on, pain following trauma= fracture; pain in hip= trochanteric bursitis

30
Q

PELVIC ROCK (ILLIAC COMPRESSION) TEST

  • pt is side lying
  • make sure patient tells you if symptoms are reproduced
  • exert downward force on illium
  • bilateral unaffected first

List Positive findings and Indications:

A

Positive findings- pain on either side SI

Indications- SI lesion (inflamatory processon affected side)

31
Q

GAENSLEN’S TEST

  • pt is supine/ instructed to slide over to one side of the table so hip of affected side is off the table
  • dr. asks pt to inform if pain or symptoms are produced prior to performance of test
  • Pt’s unaffected leg is flexed onto their chest; the opposite leg is extended off the table
  • Pt is draped appropriately
  • *Doctorstands to the side of the pt not between the pts legs
  • Doctor applies pressure to each leg to shear SI joint (applies downward pressure on the affected thigh stressing the SI joints and the anterior SI joint ligaments on the side of leg extension)
  • Bilaterally performed unaffected side first

List Positive findings and Indications:

A

Positive findings- Pain in the SI on the extended leg side

Indications- SI jt inflammation, infection, anterior SI ligament sprain

32
Q

LEWIN-GAENSLEN’S TEST

  • pt is side lying
  • Dr. asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor instruct pt to lie on unaffected side and flex the inferior leg
  • Doctor take the superior leg and extend it backwards while stabilizing the SI joint.
  • Bilaterally performed unaffected side first

List Positive findings and Indications:

A

Positive findings-(pain on the side of extension)
Extension stresses the SI joint and anterior ligaments on the side of extension)

Indications- general SI lesion (anterior SI ligament sprain (iliofemoral, ishiofemoral) or inflammatory process in SI joint

33
Q

Freiberg’s Sign

  • pt is supine
  • Dr. asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor performs an SLR
  • Doctor internally rotates the hip
  • Doctor externally rotates the hip
  • Bilaterally performed, unaffected side firs

List Positive findings and Indications:

A

Positive findings- Posterior buttocks/ leg
pain on passive internal rotation of the hip / relief of pain with external rotation

Indications- Piriformis muscle involvement –
may produce pain and hyperesthesia in sacral/gluteal region and in the sciatic
nerve distribution (piriformis syndrome)

34
Q

Piriformis Test

  • pt is side-lying
  • Dr. asks pt to inform if pain or symptoms are produced prior to performance of test
  • Pt is side-lying w/hip flexed to 60 degrees and knee fully flexed & positioned near the edge of the table
  • Doctor puts 1 hand on hip for stabilization while the other puts downward pressure on pt’s knee
  • Bilaterally performed, unaffected side first

List Positive findings and Indications:

A

Positive findings- buttock pn or sciatic radiating
pn

Indications- buttocks pn = piriformis spasm; rad pn = impingement of sciatic nerve by piriformis
(piriformis syndrome)

35
Q

Actual Leg Length

  • pt is standing (symmetrical stance, toes ahead, knees extended)
  • Doctor uses tape measure and measures bilaterally from ASIS to the floor
  • Doctorcompares bilaterally

List Positive findings and Indications:

A

Positive findings- true measure of pt’s lower extremity

Indications- A ny difference side to side indicates anatomic short leg– congenital defe
ct, impaired epiphyseal growth etc.

36
Q

Apparent Leg Length

  • pt is supine
  • Doctor uses tape measure and measures bilaterally from umbilicus to the medial malleolus
  • Doctor compares bilaterally

List Positive findings and Indications:

A

Positive findings- functional measure of pt’s lower extremity

Indications- Any difference side to side indicates functional leg deficiency may be caused by muscular or ligamentous contracture deformities– functional pelvic tilt, scoliosis, adduction or abduction deformity of hip

37
Q

Patrick Test (aka. FABERE=Flexion Abduction External Rotation Extension)

-pt is supine
- Dr. asks pt to inform if pain or symptoms are produced prior to performance of test
-Doctor passively flexes pt leg and places the foot flat on the table and grasps the femur and presses it into the acetabular cavity
-Doctor then flexes the pts hip and knee, externally rotates and abducts hip and
ankle is placed above the knee on opposite leg (sign of 4) then stabilizes opposite ASIS and presses down on the knee of the hip that is being tested
-Bilaterally performed, unaffected side first

-List Positive findings and Indications:

A

Positive findings- Pain in groin /hip or inferior gluteal fold region

Indications- Capsulitits, arthritis,
secondary to trauma: fracture, AVN, inflammatory process, et

38
Q

Laguerre’s Test

  • pt is supine
  • Doctor asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor flexes pts hip & knee to 90 degrees
  • Doctor externally rotates thigh and rotates the lower leg medially
  • Doctor presses down on the knee & pulls up on the ankle w/the other hand
  • Bilaterally performed, unaffected side first

List Positive findings and Indications:

A

Positive findings- Pain in the hip joint

Indications- Capsulitis, osteoarthritis, inflammatory process, fx of acetabular cavity or rim

39
Q

Trendelenburg Test

  • pt is standing
  • Doctor asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor places hands on patients waist and places thumbs on B/L PSIS of each ilium
  • Doctor asks pt to stand on one leg
  • Doctor has pt flex 1 hip and observe the pelvis
  • Bilaterally performed, unaffected side first

-List Positive findings and Indications:

A

Positive findings- pain on stance side or pelvis fails to rise on side of hip flexion

Indications- g. medius weakness on stance side (hip abductor weakness) or hip joint pathology on stance side

-superior gluteal nerve lesion, (often positive with dislocation of hip, fracture, subluxation, Legg-Calve Perthes disease etc.)

40
Q

Anvil Test

-pt is supine
-Doctor asks pt to inform if pain or symptoms are produced prior to performance of test
-Foot is exposed (and dorsiflexed slightly)
and dr. hits/taps the calcaneus with their fist
-Bilaterally performed, unaffected side first

-List Positive findings and Indications:

A

Positive findings- pain in groin and/upper thigh

Indications- Hip fracture (Secondary to trauma), arthritis, capsulitis etc.Pain in calcaneus –
calcaneal fracture, femoral, tibial or fibular fracture (if secondary to trauma)

41
Q

Ely’s Test

  • pt is prone
  • Doctor asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor grasps the patient’s ankle and passively flexes the knee to buttocks
  • Bilaterally performed, unaffected side first

-List Positive findings and Indications:

A

Positive findings- hip on ipsi side flexes raising buttocks off the table (spontaneous to reduce traction pressure on rectus femoris that was induced by passive knee flexion)

Indications- tight rectus femoris muscle
or hip flexion contracture: tight psoas

42
Q

Thomas Test

  • pt is supine
  • Doctor asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor asks pt to hold one knee to chest
  • Doctor palpates the quadriceps muscle of the straightened leg
  • Bilaterally performed, unaffected side first

-List Positive findings and Indications:

A

Positive findings- Patient involuntarily flexes the opposite leg and tightness is palpated on that side

Indications- hip flexion contracture / if tightness is not palpated possible cause is restriction at the hip joint or joint capsule

43
Q

Ober’s Test

  • pt is side-lying, lower leg flexed at hip and knee for stability
  • Doctor asks pt to inform if pain or symptoms are produced prior to performance of test
  • Doctor passively abducts and extends leg with knee straight (or flexed to 90 degrees)
  • Doctor applies an I-S stabilizing pressure on the pelvis
  • Doctor ask pt to slowly lower their thigh down towards table
  • Bilaterally performed, unaffected side first

-List Positive findings and Indications:

A

Positive findings- thigh remains elevated when abducted and/or fails to descend smoothly

Indications- iliotibial band or TFL contracture

44
Q

Allis Test

  • pt is supine
  • Doctor instructs pt to flex knees and hips to approx. 45 degrees
  • Doctor makes sure heels are lined up
  • Doctor observes from the lateral aspect for femoral length
  • Doctor observes from the foot of the table for tibial length

-List Positive findings and Indications:

A

Positive findings- femur protrudes father caudally and/or tibia protrudes higher

Indications- Femoral length discrepancy and /or tibial length discrepancy

CONA 1 (6 decks)

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