Lower back and leg pain Wk 4 Flashcards
Lumbar spine bony palpation
- lumbar spinous process
- sacral tubercles
- iliac crest
- PSIS
Lumbar soft tissue palpation
- paraspinal muscles (i love spine lateral to medial)
- iliocostalis
- longissimus
- spinalis - sciatic nerve (b/t isichial tube and greater trochanter)
- gluteus maximus (SI to greater tro)
- gluteus medius (greater tro to crest)
- Hamstrings
- biceps femoris
- semitendinosus
- semimembranosus
- anterior abdominal muscles
- ASIS
lumbar spine range of motion
flexion 25
extension 30
left/right lateral flex 25
rotation 30
Hoover sign/test
- pt supine, lifts leg while dr holds under heel of other leg
- lack of counter pressure on healthy side indicates lack of organic basis for paralysis, possible malingering. With true hemiplegia, pt will still exert downward pressure when raising paralyzed leg
Straight Leg raise
pt supine, dr raises the leg to 90 or until pain
-radiating pain and/or dull posterior thigh pain indicates sciatic radiculopathy or tight hamstrings. 35-70 degrees discogenic sciatic radiculopathy. more than 70 tight hamstrings.
Goldthwait sign
pt supine. place fingers of superior hand in lumbar interspinous spaces, then raise each leg
-localized pain, low back or radiating pain down the leg indicates lumbosacral or sacroiliac pathology. pain occurring after lumbars move is lumbo-sacral problem, pain before the lumbars move indicates sacroiliac problem
Bragard Sign
while doing SLR, pt experiences pain, drop leg 5 degrees and dorsiflex foot
-radiating pain in posterior thigh indicates sciatic radiculopathy
Buckling Sign
while doing SLR patients knee suddenly flexes
-pain in the posterior thigh with sudden knee flexion indicates sciatic radiculopathy
Bowstring Sign
supine, hip and knee at 90. Sit next to pt with their leg resting on your shoulder. press into the belly and tendons of hamstrings as well as popliteal fossa
-pain in the lumbar region or radiculopathy indicates sciatic nerve root compression, helps rule out tight hamstrings
Lasegue test
supine. hip and knee at 90. slowly extend knee keeping hip at 90
- reproduction of sciatic pain before 60 degrees indicates sciatica
Milgram test
supine. ask pt to raise both legs 2-3 inches off table and hold for 30 secs
- inability to perform test and/or low back pain indicates weak abdominal muscles or space occupying lesion
Valsalva
seated. instruct pt to take deep breath and hold while bearing down as if straining during bowel movement
- radiating pain from site of lesion usually recreating the complaint in cervical or lumbar area of the spine indicates space occupying lesion, disc pathology for example
Bechterew Test
pt seated. ask to extend each leg. then both. looking for tripod sign
-reproduction of radicular pain or inability to perform correctly due to tripod sign indicates sciatic radiculopathy
Neri Bowing Test
ask pt to bend forward at the waist
-pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side indicates a positive for a variety of low back pathologies. hamstring tension of the pelvis may trigger response
Anterior Innominate Test aka?
aka Mazion Pelvic Manuever
standing. pt takes step forward and bends to touch forward toe (same results as SLR)
-the inability to bend at the waist more than 45 d because of either/or radiating pain along the sciatic nerve (uni or bilateral) indicates sciatic neuralgia or radiculopathy or low back pain either lumbar or pelvic region indicates anterior displacement of the ilium relative to sacrum
Lewin Standing Test
standing. ask them to bend slightly at hips and slightly at knees. stabilze low back, then push each knee into extension, then both.
- radiating pain down the leg causing flexion of the patients knee or knees indicates gluteal, lumbosacral or sacroiliac pathologies.
Heel walk
-inability to perform indicates L4-L5 disc lesion (L5 nerve root)
Toe walk
inability to perform test indicates L5-S1 disc lesion (S1 nerve root)
Ely Heel to Buttock Test
prone. take heel to opposite buttock. one hand under knee, other hand stabilze top of iliac crest. lift knee (hip extension)
- inability to raise the thigh indicates iliopsoas spasm, pain in anterior thigh indicates inflammation of lumbar nerve root, and pain in lumbar region indicates lumbar nerve root adhesions
L4 nerve root
disc level: L3
muscle test: foot dorsiflexion & inversion- tibialis anterior deep peroneal nerve
reflex: patellar
sensation: medial leg and big toe
L5 nerve root
Disc level: L4
Muscle test:
-foot dorsiflexion (extensor hallicus longus and extensor digitorum longus/brevis, deep peroneal nerve)
-Big toe dorsiflexion (extensor hallicus longus, deep peroneal)
-toes 2,3,4 dorsiflexion (extensor digitorum longus/brevis, deep peroneal nerve)
-hip and pelvis abduction (gluteus medius and minimus, superior gluteal nerve)
Reflex: NONE
Sensation: lateral leg, top of foot, middle three toes
S1 nerve root
Disc Level: L5
Muscle test:
-foot plantarflexion (gastroc and soleus, tibial nerve)
- foot plantarflexion and eversion ( peroneus longus and brevis, superfical peroneal nerve)
-Hip extension ( gluteus max, inferior gluteal nerve)
Reflex: Achilles
Sensation: posterior leg, lateral foot, lateral little toe
Bony Palpation of Hip
Anterior: ASIS Iliac crest iliac tubercle greater trochanter Posterior: PSIS ischial tuberosity coccyx
Soft Tissue Palpation of Hip
-Femoral Triangle borders
sartorius
adductor longus
inguinal ligament
-Quadriceps muscles
vastus lateralis
vastus medialis
vastus intermedius
rectus femoris
-greater trochanteric bursa
-gluteus medius
-gluteus maximus
-sciatic nerve
-cluneal nerves
-hamstrings
biceps femoris
semitendinosus
semimembranosusHip Range of motion
flexion 120
extension 30
abduction/ adduction 45
internal/external 45
Leg length discrepancy
supine. measure true length from ASIS to medial malleolus on both legs. measure for apparent length from ulbilicus to medial malleolus on both sides
- different measurements for true length indicates bony abnormality above or below level of trochanter, anatomical short leg. different measurements for apparent length is pelvic obliquity or tilted pelvis
Allis sign
supine, flex both knees to 90d.
- if one knee is lower indicates ipsilateral congenital hip dislocation or tibial discrepancy, anatomical short leg
- if one knee is anterior indicates ipsilateral congenital hip dislocation or femoral discrepancy
Thomas test
supine. ask pt to hold knee to chest while keeping other extended. check for contralateral knee to raise and that the lumbar spine is flattened
- lumbar spine maintains lordosis (it should flatten) and hip or leg flexes indicates contracture of the hip flexors, iliopsoas
Anvil test
supine. use heel of your hand to strike the heel, inferior to calcaneous
- localized pain in long bone or in hip joint indicates possible fracture of long bones or hip pathology
Patrick Test aka?
aka FABERE sign
supine, figure 4 with one leg, stabilize opposite ASIS, apply downward pressure to bent leg, above knee
-pain in the hip region indicates hip joint pathology
Laguerre test
same as patrick but pts ankle rests in your elbow. apply downward pressure
-pain in the hip joint indicating hip point pathology or pain in the sacroiliac joint indicating mechanical problem of SI joint
Gaenslen test
supine, SI joint off table, grabs other leg and brings to chest, then place downward pressure on leg close to edge until it is lower than table
-pain on the affected SI joint stressed into extension indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
Lewin- Gaenslen test
lying on side, inferior leg flexed. grasp superior leg and bring into extension while stabilizing hip
-pain on the affected SI joint stressed into extension indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
Hibbs test
hibb hibb away!
prone, stand on opposite side. grab leg and flex to butt, then rotate away from body
-pain in the hip region indicates hip joint pathology, or pain in the buttock/pelvic region indicates sacroiliac joint lesion
Ober Test
side laying, knees flexed. grab ankle abduct and extend leg
-affected leg remains in abduction (should adduct back down if normal) indicates contraction of iliotibial band or tensor fascia lata
Pelvic Rock Test aka?
aka Iliac compression test
side laying. find halfway between trochanter and iliac crest. then apply downward (lateral to medial) pressure and rock the ilium on sacrum
-pain in either sacroiliac joint indicates sacroiliac joint lesion
Nachlas Test
prone. bring same side your standing on leg to buttock and stabilize same side crest
- pain in the buttock and/or pain in the lumbar region indicates a sacroiliac joint lesion or lumbar pathology
Yeoman Test
prone, flex pts knee to ipsilateral buttock. stabilze same side crest, grab under knee, extend leg
-pain deep in the sacroiliac joint indicate sprain of anterior sacroiliac ligaments
Ely Sign
just bring heel to buttock and look at hips
-hip on side being tested will flex causing the buttock to raise off the table indicates rectus femoris or hip flexor contracture
Ely Heel to Buttock
bring heel to contralateral buttock, stabilize crest on same side your standing. grab under knee and bring leg into extension
-inability to raise thigh indicates iliopsoas spasm, pain in the anterior thigh indicates inflammation of lumbar nerve roots, and pain in the lumbar region indicates lumbar nerve root adhesions
Trendelenburg Test
have pt stand on one leg while looking at hips
-high iliac crest on standing side while low crest on elevated leg indicates weak gluteus medius muscle on the supported side
Minor Sign
from seated. ask pt to stand. and observe or abnormal motion
-knee flexion of affected leg while supporting upper body weight on unaffected side indicates sciatica or lumbosacral joint lesion
Belt Test
standing. support hips. ask them to bend forward. then stabilize them with your side and ask them to bend forward
- low back pain while bending both times indicates lumbar involvement, pain only while unstabilzed indicates pelvic involvement
Kemp test
seated. laterally flex them and stabilize opposite PSIS and bring the shoulder back into extension and rotation
- reproduction of pain radiating into the leg while leaning toward the affected leg will indicate a lateral disc protrusion. If pt experiences pain leaning away from affected leg indicates a medial disc protrusion. if pt experiences local pain indicates facet capsulitis.
Lindner Sign
pt supine, flex pts head toward chest
-pain along sciatic nerve distribution or sharp, diffuse pain in leg indicates sciatic radiculopathy
Turyn Sign
supine. dorsiflex big toe
- pain in the gluteal region or radiating sciatic pain indicates sciatic radiculopathy
Sicard Sign
just like bragard. do SLR, bring leg back down until pain relieves, then dorsiflex big toe
-posterior thigh and leg pain indicates sciatic radiculopathy, usually from disc lesion
Bonnet Sign
supine. raise leg, internally rotate (towards other leg) and adduct hip across midline (stretches piriformis) then do SLR toward opposite shoulder
- pain in the posterior thigh or leg indicates immediate sciatic neuropathy from piriformis syndrome
Fajersztajn Test aka
aka cross over sign aka well leg raise test
supine, do SLR on unaffected leg, if no pain then do bragards on unaffected leg
-pain down the affected leg indicates medial disc protrusion, if theres a decrease in pain down the affected leg indicates a lateral disc protrusion
Femoral Stretch Test aka?
femoral nerve traction test
laying on side and tuck chin, bend knee, stabilze hip and bring leg into extension
-pain on the anterior portion of the thigh indicates traction on the femoral nerve indicating involvement of the 2nd 3rd and 4th lumbar nerve roots.
