LE Neural tests part 2 (standing, prone, SI) Flashcards
What are the other names for a belt test?
Supported Adam’s test
Supported forward bending test
If a patient feels great in the tub and worse getting out of the tub what condition may be suspected?
SI joint lesion
Which orthopedic test/sign is used to differentiate a lumbo-sacral issue vs an SI problem?
A. Lewin’s standing
B. Neri’s Bowing sign
C. Belt test
D. Advancement Test
E. Braggard’s test
C. Belt test
How is an Adam’s test performed?
Observe patient with structural scoliosis standing
Then ask patient to file forward at the waist while the doctor observes the patients back for signs of structural change
What is a doctor looking for when a patient bends forward for an Adam’s test?
Scapular winging, rib humping, iliac crest height
What are the positive findings for an Adam’s test?
Resolution of structural findings
What are the indications for the positive findings for an Adam’s test?
Resolution indicates functional scoliosis
No resolution indicates structural scoliosis
A patient performs an Adam’s and their scapular winging and rib humping goes away. How is this recorded and what is indicated?
Positive Adam’s test indicating functional scoliosis
A patient performs an Adam’s test and their rib humping and iliac crest height differential does not go away. How is this recorded and what is indicated?
Positive Adam’s test indicating structural scoliosis
How is a Belt/Supported Forward Bend/Supported Adam’s test performed?
- Instruct pt to bend fully forward toward their toes and note when pain begins
- have pt contact both ASIS
- Repeat while dr stands behind pt and blocks SI joint motion by supporting sacrum with their thigh/hip and pulling backward on ASIS bilaterally over pt’s hands (prevents flexion below level of LS junction)
What are the positive findings for a Belt/Supported Forward Bend/Supported Adam’s test?
Decrease in pain upon supported flexion
Increase in pain at an earlier angle
What is indicated by a positive finding for a Belt/Supported Forward Bend/Supported Adam’s test?
Source of pain in the unsupported Adam’s test was of SI origin if pain decreases
(SOF: If pain increases at an earlier angle may indicate a LS problem)
What test is performed standing to determine if the source of a patients low back pain is of SI origin?
Belt test/Supported Adam’s test/Supported Forward bending test
A Belt test is performed and the patient has increased pain at an early angle before completing forward flexion, how is this recorded and what does it indicate?
Positive indicating LS involvement
A Belt test is performed and the patient has a decrease in pain in forward flexion, how is this recorded and what does it indicate?
Positive indicating SI involvement
What is Neri’s sign also called?
Bowing sign or Knee flexion test
How is a Neri’s sign performed?
Patient stands and bends forward from the waist
What is a present finding for Neri’s/Bowing sign?
Patient’s affected leg flexes at the knee and the patient reports reproduction of the LE complaint in this position
What is indicated by a present Neri’s/Bowing sign?
Sciatic radiculopathy, hamstring spasm, SI lesion, or LS strain
A present Neri’s/Bowing sign will be present with knee flexion on the (Asymptomatic/Symptomatic) side?
Symptomatic
What test is performed after a Neri’s/Bowing sign if present?
Lewin’s Standing test
How is a Lewin’s Standing test performed?
If the patient’s knee is flexed when standing normally, or with performance of Neri’s test, the examiner stabilizes the patient’s pelvis then attempts to pull the flexed knee back into extension
What is a positive result for a Lewin’s Standing test?
Increase in posterior leg pain or inability to keep the leg straight
What is indicated by a positive result for a Lewin’s Standing test?
Sciatic radiculopathy or hamstring spasm
What standing LE orthopedic tests can indicate sciatic radiculopathy or a hamstring spasm?
Neri’s sign
Lewin’s standing test
Advancement test
How is an advancement test performed?
The patient bends forward to elicit pain into the leg
The patient is then asked to advance the SYMPTOMATIC leg one step and bend forward again
What is a positive result for an advancement test?
Reproduction of the radiating pain with less trunk flexion than before
What is indicated by a positive result for an advancement test?
Sciatic radiculopathy, sciatic neuritis, hamstring spasm
What two prone LE tests can be positive for facet syndrome?
Nachlas test
Ely’s Heel to Buttock Test
If a Nachlas test is performed and a patient points to the anterior thigh as their site of pain. How is this recorded?
Positive femoral nerve traction test with a negative Nachlas test
How is Nachlas test performed?
Approximate the patient’s heel to the IPSILATERAL buttock and ask the patient to localize the site of pain
For a Nachlas test the examiner approximates the patient’s heel to the (Ipsilateral/Contralateral) buttock?
Ipsilateral
What is a positive finding for a Nachlas test?
Pain localized by a patient
What is indicated by a positive finding for a Nachlas test?
Non-specific LS, SI, or facet pain (if in lower back)
Femoral nerve root irritation