Lower Quadrant

Question 1

Initial Observation

Answer 1

observe in waiting room, sitting position, sit > stand, facial expression, ADL, Gait

Question 2

Postural Exam

Answer 2

head position, shoulder height, spinal alignment, iliac crests, leg length, foot posture, lateral shift?

Question 3

Quick Tests

Answer 3

full squat (w/ feet flat), heel raise (B/L and U/L, PF + S1), stand on heels (DF= L4-5), gait, balance, SLS (neutral? glut med? lateral shift?), Romberg (Stand feet together, eyes closed, + is swaying)

Question 4

AROM of L/S

Answer 4

Check for: willingness to move, excursion, quality of motion in forward bending, backward bending, side bending, rotation… if AROM is painfree, apply overpressure
Gour’s Sign: uses hands to return to upright from forward bending, (+) for instability

Question 5

More AROM if cardinal movements painfree

Answer 5

• Ext, SB, Rot (ipsilateral hand to back of thigh, would irritate ipsilateral facet)
• Flexion, SB, Rot (contralateral hand to front of thigh, would irritate contralateral facet)

Question 6

Outcome Measures

Answer 6

McGill Pain Scale (very long), FABQ (lower score associated with increased return to work), Owestry (0-10)

Question 7

Special Questions

Answer 7

type of mattress, sleep position, effect of prolonged sitting, effect of coughing, sneezing, valsalva, effect of sit > stand, strength, motor control

Question 8

General Q’s re: health

Answer 8

general health, bladder retention/ incontinence, groin numbness, unexpected weight loss, night sweats, unrelenting night pain, PMH of CA, if fluct w/ meals, refer to GI, Meds, Imaging, fatigue

Question 9

Deep Tendon Reflexes

Answer 9

Paella Tendon (L4), Achilles(S1), 0- albsent, 4+ hyperreflexive

Question 10

UMN Testing

Answer 10

Babinski and clonus

Question 11

Hip, knee, ankle Screen

Answer 11

A/PROM, Resistance, Palpate piriformis, FADDIR, FABER, ASLR with compression

Question 12

Slump Test

Answer 12

Long sitting: Flex spine, flex neck, extend knee, DF ankle; if shooting pain (+), if neural tension releases with cervical extension (+),

Question 13

pSLR, Lasegues’ test

Answer 13

passive SLR up to 70 (+) pain for disc herniation, inc with C/S flexion

Question 14

Femoral nerve stretch, prone knee bend

Answer 14

same test, fem nerve can also be done S/Ling, (+) for upper lumbar herniation or neural adhesions

Question 15

compression of trunk

Answer 15

supine, knees to chest, apply superior force to ITs with forearm

Question 16

distraction of trunk

Answer 16

hook-lying, wrap arms around distal femur & WS back

Question 17

Tests to increase intrathecal pressure

Answer 17

Milgram (B/L SLR), Nafziger (palpate jugular and compress), Valsalva

Question 18

SIJ Tests for CPR: Anterior gapping

Answer 18

heel of palms on medial aspect ofC/L ASISs, apply lateral force pushing ASISs away

Question 19

SIJ Tests for CPR: Posterior distraction

Answer 19

press ASISs in towards one another with medial force, or S/Ling, apply inferior force

Question 20

SIJ Tests for CPR: Gaenslen’s Test

Answer 20

Pt is supine, bring one knee to chest, other knee and SI off the table, press bottom LE inferiornly and innominate bone should rotate

Question 21

SIJ Tests for CPR: Compression/ SPring Test

Answer 21

Pt prone, hand on sacru, arm perpendicular, give it an inferior force

Question 22

SIJ Tests for CPR: Thrust Test

Answer 22

Thomas position, hold distal femur and give inferior force, other hand on SI feel for movement

Question 23

Correlation of nerves on ant thigh

Answer 23

Anterior femoral cutaneous nerve with L2

Question 24

Correlation of nerves on lateral superior thigh

Answer 24

L1 and lateral cutaneous femoral nerve

Question 25

Correlation Medial leg

Answer 25

L4 and saphenous nerve

Question 26

Correlation anterior leg

Answer 26

L5 or combo superficial fibular nerve lateral to tibia) and medial crural branch of saphenous nerve

Question 27

correlation lateral leg

Answer 27

S1, superficial fibular nerve

Question 28

Correlation posterior lateral leg

Answer 28

Sural cutaneous nerve, S1

Question 29

Correlation posterior medial leg

Answer 29

S2, saphenous nerve