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NYCC Patient Assessment 1 > LE neural tension tests > Flashcards

LE neural tension tests Flashcards

1
Q

What are potential history questions to ask for a LE orthopedic exam?

A

Do you have any low back or leg pain?
What position makes you feel better or worse?
Is the pain sharp or shooting?
Do you tend to trip of stumble?
Do you have any numbness in your legs or feet?

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2
Q

A gluteus maximus muscle test evaluates which nerve(s)?

A

Inferior gluteal nerve

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3
Q

The Achilles reflex evaluates which nerve(s)?

A

Tibial nerve
S1 nerve root

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4
Q

What nerves correspond to the area on the lateral lower leg?

A

Superficial fibular nerve
L5 nerve root

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5
Q

A patient with a medial disc herniation will lean (Towards/Away from) the affected side?

A

Towards

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6
Q

A patient with a lateral disc herniation will lean (Towards/Away from) the affected side?

A

Away from

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7
Q

Pain in an extremity is called what?

A

Claudication

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8
Q

If a patient leans to the right and the pain in their leg gets better on the left where is the herniation?

A

Lateral to the nerve root

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9
Q

If a patient leans to the left and the pain in their leg gets better on the left where is the herniation?

A

Medial to the nerve root

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10
Q

The side of herniation is the side of ____

A

Leg pain

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11
Q

What nerve root traction tests for the LE test for RADICULOPATHY AND NEUROPATHY?

A

Turyn’s Test
Straight Leg Raise
Sicard’s Test
Braggard’s Test

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12
Q

How is Turyn’s Test performed?

A

Doctor dorsiflexes the great toe while the leg is at rest

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13
Q

What is a positive finding for Turyn’s test?

A

Sharp shooting pain down the back of the leg or exacerbation of LE complaint

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14
Q

What is indicated by a positive result for Turyn’s test?

A

Sciatic nerve root traction and irritation

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15
Q

What nerve is being tested for Turyn’s test?

A

Sciatic

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16
Q

How is a straight leg raise test performed?

A

Doctor elevates SYMPTOMATIC leg with knee extended bracing with one hand on the top of the knee
Leg is elevated until patient reports pain or knee flexion occurs
Note the angle of pain and ask patient to point to the site of pain

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17
Q

What is a positive finding for a straight leg raise test?

A

Sharp shooting pain down the back of the leg or exacerbation of LE complaint

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18
Q

What is indicated by a positive result for a straight leg raise test?

A

Sciatic neuropathy/nerve root, hamstring dysfunction, piriformis syndrome

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19
Q

What muscle group may be lesioned in a positive straight leg raise test?

A

Hamstring

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20
Q

What peripheral nerve may be lesioned in a positive straight leg raise test?

A

Sciatic

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21
Q

A straight leg raise test is performed and the patient reports femoroacetabular, sacroiliac, and low back pain. How would you record this result?

A

Negative with SOFs of LBP, FA pain, and SI pain

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22
Q

How is Sicard’s test performed?

A

Perform straight leg raise and lower the leg below the angle of pain and dorsiflex the great toe

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23
Q

What is a positive finding for Sicard’s test?

A

Sharp shooting pain down the back of the leg or exacerbation of LE complaint

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24
Q

What is indicated by a positive Sicard’s test?

A

Sciatic nerve root traction and irritation

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25
Q

What LE nerve root traction test can differentiate a hamstring pathology from a sciatic nerve lesion for a positive straight leg raise?

A

Sicard’s test

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26
Q

What LE nerve root traction test is used following a POSITIVE straight leg raise test?

A

Sicard’s/Braggard’s test

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27
Q

What LE nerve root traction test rules out a hamstring, SI, or hip pathology as the tissue of causation for a positive straight leg raise?

A

Braggard’s test

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28
Q

With a Sicard’s test you dorsiflex the (Foot/Great toe)?

A

Great toe

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29
Q

With a Braggard’s test you dorsiflex the (Foot/Great toe)?

A

Foot

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30
Q

How is a Braggard’s test performed?

A

Following a positive straight leg raise lower the leg until the pain eases then dorsiflex the FOOT

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31
Q

What is a positive finding for Braggard’s test?

A

Sharp shooting pain down the back of the leg or exacerbation of LE complaint

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32
Q

What is the indication for a positive result for Braggard’s test?

A

Sciatic nerve root traction and irritation

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33
Q

Is Braggard’s or Sicard’s test more aggressive?

A

Braggard’s

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34
Q

What LE orthopedic nerve root traction tests are used for RADICULOPATHY ONLY?

A

Well leg raise
Lindner’s Sign

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35
Q

What are other names for a well leg raise?

A

Contralateral Lasegue
Crossed straight leg raise
Crossed sciatic
Fajerszatjn’s

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36
Q

What is the only case so far where we start on the symptomatic side first?

A

Straight leg raise

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37
Q

How is a well leg raise test performed?

A

Raise the NON-SYMPTOMATIC leg as per straight leg raise
Then lower the leg below the point of pain and DORSIFLEX THE FOOT

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38
Q

What is a positive finding for a well leg raise?

A

Exacerbation of pain in the posterior aspect of the SYMPTOMATIC LEG at any point in the test

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39
Q

What is indicated by a positive result of a well leg raise?

A

Nerve root lesion suggesting a MEDIAL disc herniation

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40
Q

A positive result for a well leg raise indicates a (Medial/Lateral) disc herniation?

A

Medial

41
Q

How is Lindner’s sign performed?

A

The examiner flexes the patients cervical and thoracic spine into flexion and notes any exacerbation of low back and radiating pain (seated or supine)

42
Q

What is a present finding for Lindner’s sign?

A

Exacerbation of pain in the posterior aspect of the SYMPTOMATIC leg upon cervical flexion, or exacerbation of LE complaint

43
Q

What is the indication for a present finding for Lindner’s sign?

A

Sciatic radiculopathy indicative of a LATERAL disc herniation

44
Q

A present finding for Lindner’s sign indicates a (Medial/Lateral) disc herniation with sciatic radiculopathy?

A

Lateral

45
Q

A present Lindner’s sign indicates a lateral disc herniation where in the spine?

A

Lumbar spine

46
Q

If a patient complains of pain in the leg when looking down what is the appropriate test and a possible dx?

A

Lindner’s sign possibly with a lateral lumbar disc herniation

47
Q

What orthopedic test is used to differentially diagnose radiculopathy from other conditions?

A

Bowstring sign

48
Q

How is a Bowstring sign performed?

A

Straight leg raise is positive, while maintaining the symptomatic angle, the leg is flexed at the knee with the ankle resting on the examiners shoulder
If pain is reported the doctor exerts firm pressure at the medial, then lateral, then both hamstring tendons, and then to the popliteal fossa to compress the sciatic nerve

49
Q

What is a present finding for a Bowstring sign?

A

Pain

50
Q

What is a present finding when pushing on the popliteal fossa for a Bowstring sign?

A

Pain in the lumbar region suggesting radiculopathy

51
Q

What is indicated by a present finding when pushing on the popliteal fossa for a Bowstring sign and the patient has pain shooting down the leg?

A

Sciatic neuritis

52
Q

What is a present finding when pushing on the hamstring tendon for a Bowstring sign?

A

Pain at the hamstring tendon with palpation

53
Q

What is indicated by a present finding when pushing on the popliteal fossa and the patient gets pain in the lumbar region?

A

Radiculopathy

54
Q

What is indicated by a present finding when pushing on the hamstring tendon for a Bowstring sign?

A

Hamstring tendon (strain) as the source of leg pain

55
Q

What LE orthopedic tests are used specifically for a piriformis evaluation?

A

Piriformis stretch test
Bonnet’s test

56
Q

How is a piriformis stretch test performed?

A

With patient prone, flex knee to 90°, WITH STABILIZATION of opposite iliac crest, passively internally rotate the hip

57
Q

What is a positive finding for a piriformis stretch test?

A

Exacerbation of sciatic symptoms (shooting pain for the leg or right feeling in the glutes)

58
Q

What is indicated by a positive finding for a piriformis stretch test?

A

Piriformis entrapment of the sciatic nerve

59
Q

What LE piriformis evaluation test is used after a positive straight leg raise?

A

Bonnet’s test

60
Q

How is a Bonnet’s test performed?

A

After a positive straight leg raise the doctor externally rotates the hip and slightly ABducts the LE, then internally rotates the patients hip and slightly ADducts the LE

61
Q

What are the positive findings for a Bonnet’s test?

A

Decreased sciatic pain upon external rotation and ABduction
Increased sciatic pain upon internal rotation and ADduction

62
Q

What is indicated by a positive finding for a Bonnet’s test?

A

Piriformis entrapment of the sciatic nerve

63
Q

If a Bonnet’s test is performed what is the positive result during external rotation of the hip?

A

Decreased sciatic pain

64
Q

If a Bonnet’s test is performed what is the positive result during internal rotation and ADduction of the hip?

A

Increased sciatic pain

65
Q

What LE orthopedic tests are used to differentiate lumbar from SI joint involvement?

A

Goldthwaite test
Smith-Petersen
Double leg raise

66
Q

How is a Goldthwaite test performed?

A

Patient is supine, examiner performs a straight leg raise while palpating the lumbosacral junction

67
Q

What is a positive result for a Goldthwaite test?

A
  • Pain BEFORE LS junction opens = IPSILATERAL SI lesion
  • pain when LS junction moves = LS lesion
  • pain AFTER LS junction moves = CONTRALATERAL SI lesion
68
Q

If a positive result for a Goldthwaite test is pain before the LS junction opens where is the lesion?

A

Ipsilateral SI

69
Q

If a positive result for a Goldthwaite test is pain when the LS junction moves where is the lesion?

A

LS junction

70
Q

What is indicated by a positive result for a Goldthwaite test?

A

SI lesion or LS lesion

71
Q

What LE orthopedic test can follow a positive Goldthwaite test?

A

Smith-Petersen test

72
Q

How is a Smith-Petersen test performed?

A

Following a positive Goldthwaite test, a SLR is performed on the ASYMPTOMATIC side and the angle of SLR is compared to the positive in Goldthwaite test

73
Q

What is a positive result for a Smith-Petersen test?

A
  • If the well leg can be elevated higher (after LS movement) it confirms SI involvement on the symptomatic side
  • If the well leg can be raised no higher than when LS moves, it confirms LS involvement
  • If well leg cannot be raised to the point of LS movement, it confirms SI involvement on the ipsilateral side
74
Q

If a Smith-Petersen test is performed and the well leg is elevated higher than the symptomatic side from a Goldthwaite test, what is the positive finding?

A

Contralateral SI joint lesion

75
Q

If a Smith-Petersen test is performed and the well leg is elevated to the same height as the Goldthwaite test or below, what is the positive finding?

A

LS lesion

76
Q

What is a double leg raise test also called?

A

Bilateral straight leg raise

77
Q

How is a double leg raise test perfomed?

A

Patient is supine and a straight leg raise is performed on one leg and then the other noting the angles at which the pain begins
Then LIFT BOTH LEGS SIMULTANEOUSLY and note the angle at which pain begins

78
Q

What two tests are performed following a Goldthwaite test?

A

Smith-Petersen
Double leg raise

79
Q

What is a positive finding for a double leg raise test?

A

Reproduction of LS pain at the lesser angle than with the individual straight leg raise

80
Q

What is indicated by a positive finding for a double leg raise test?

A

Lumbosacral joint involvement (sprain or disc disease)

81
Q

What are seated LE orthopedic tests?

A

Minor’s sign
Bechterew’s test
Kemp’s test

82
Q

How is a Minor’s sign performed?

A

Observe the patient while rising from a seated position

83
Q

What is a present finding for a Minor’s sign?

A

The use of the patient’s arms while rising and maintenance of the affected leg in flexion by leaning forward and jackknifing the upper body over the legs

84
Q

What is indicated by a present finding for a Minor’s sign?

A

Non-specific indicator of the presence of pain of low back or lumbopelvic origin

85
Q

How is Bechterew’s test performed?

A
  • patient actively extends symptomatic leg, lower it,
  • repeat with opposite leg
  • If no exacerbation of pain then instruct patient to extend both knees simultaneously
86
Q

For Bechterew’s test you start on the (Symptomatic/Asymptomatic) side?

A

Symptomatic

87
Q

What two LE orthopedic tests start on the SYMPTOMATIC side?

A

Straight leg raise test
Bechterew’s test

88
Q

What are positive findings for a Bechterew’s test?

A

Pain or falling back into a tripod position with patient leaning back on the hands

89
Q

What is indicated from a positive finding for a Bechterew’s test?

A
  • symptomatic leg = radiculopathy secondary to disc, hamstring tightness, piriformis syndrome (same as SLR)
  • opposite leg = medial disc (same as WLR)
  • both legs = sciatic nerve traction indicating disc lesion
90
Q

A patient performs Bechterew’s test and raises their right leg and has pain down the right leg, what is the interpretation for this positive?

A

Sciatic radiculopathy

91
Q

A patient performs Bechterew’s test and raises their right leg and has pain down the left leg, what is the interpretation for this positive?

A

Medial disc herniation

92
Q

How is Kemp’s test performed?

A

Note antalgic position first and with the patient seated contact the low back at the site of pain.
Bring the patients upper body into extension, Ipsilateral lateral flexion, and rotation simultaneously’

93
Q

Kemp’s test can diagnose between a medial vs a lateral disc herniation (TRUE/FALSE)?

A

t

94
Q

What is a positive finding for Kemp’s test?

A

Sharp shooting pain down the extremity indicating a disc lesion
If seated, preload on the disc is increased

95
Q

What is indicated by a positive finding for Kemp’s test?

A

Nerve root compression caused by disc

96
Q

What seated LE orthopedic test can confirm radiculopathy?

A

Kemp’s test

97
Q

What can indicate facet syndrome during Kemp’s test?

A

Local pain that is dull, boring, or achy with the patient standing to increase load on the facets

98
Q

A Kemp’s test is performed with the patient standing and they have worsening localized low back pain, how is this recorded and what is the interpretation?

A

Negative indicating facet syndrome

99
Q

A Kemp’s test is performed with the patient seated and they have sharp shooting pain down the extremity, how is this recorded and what is the interpretation?

A

Positive indicating a disc herniation

NYCC Patient Assessment 1 (15 decks)

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