LPHC Examination: Palpation And Special Tests Flashcards
1
Q
What DTRs should we test in LPHC examinations?
A
Patellar tendon
Posterior tibial
Medial HS
Achilles tendon
Lat HS
2
Q
What DTR is L3/4?
A
Patellar tendon
3
Q
What DTR is L4/5?
A
Posterior tibial
4
Q
What DTR is L5/S1?
A
Medial HS
5
Q
What DTRs are S1/2?
A
Achilles tendon and lateral HS
6
Q
What is the dermatomal distribution of L1/2?
A
Lateral anterior hip, groin, iliac crest, medial thigh
7
Q
What dermatomal distribution is L3?
A
Antero-medial thigh
Knee
Lower leg
8
Q
What dermatomal distribution is L4?
A
Lateral thigh, medial shin, medial foot, great toe
9
Q
What dermatomal distribution is L5?
A
Lateral lower leg, toes 2-5, plantar foot toes 1-3
10
Q
What dermatomal distribution is S1/2?
A
Lateral foot, heel, plantar toes 4-5, and plantar heels
11
Q
What is the myotomal action of L1/2?
A
Hip flexion
12
Q
What is the myotomal action of L3?
A
Knee extension
13
Q
What is the myotomal action of L4?
A
Ankle DF
14
Q
What is the myotomal action of L5?
A
Great toe extension
15
Q
What is the myotomal action of S1?
A
Ankle PF, eversion, hip extension
16
Q
What is the myotomal action of S2?
A
Knee flexion
17
Q
The lumbo-pelvic special tests are based on what?
A
Static positional faults
Movt deficits
Symptom reproduction (most reliable)
18
Q
The use of what two things in LPHC examination can increase our confidence in what we think is going on?
A
Trial treatment and cluster of tests
19
Q
What are the symptom reproduction tests for the LPHC?
A
Quadrant sign
SI gap/compression
Gaenslen test
Posterior shear test (POSH)
FABER test
Resisted abduction test
Fortin finger test
SI cluster
20
Q
What is the Quadrant test?
A
A LPHC symptoms reproduction test where the pt is seated, BB, SB, and rotating with overpressure for max closing
21
Q
What is a positive quadrant sign?
A
Reproduction of symptoms for lumbar closing dysfunction and possibly facet irritation
22
Q
What is the SI gap/compression test?
A
A LPHC symptom reproduction test where the pt is supine and you apply a gap or compression force to the ilia by pulling apart or pushing together the ASISs
Can do the compression in SL too
23
Q
What is a positive SI gap/compression test?
A
Reproduction of symptoms for SIJD
24
Q
What is the Gaenslen test?
A
A LPHC symptom reproduction test where the pt is in supine with one knee to their chest and the other dangling off the table, we apply overpressure to the knee to chest and stabilize or push into extension the other leg hanging off the table
25
What is a positive Gaenslen test?
Reproduction of symptoms for SIJD
26
What is the posterior shear (POSH) test?
A LPHC symptom reproduction test where the pt is in supine and you apply compression through the long axis of the femur with the hip at about 90deg flexion
27
What is a positive POSH test?
Reproduction of symptoms for SIJD
28
What is the FABER test?
A LPHC symptom reproduction test where the or is in supine and you passively move their leg into FABER and apply compression to the knee and opposite ASIS
29
What is a positive FABER test?
Reproduction of symptoms for SIJD
30
If a pt can’t get into the position for a FABER test, what should we do?
Do the test where they can get to and if they get pain getting into the position, ask them where the pain is
31
What is the resisted abduction test?
A LPHC symptom reproduction test looking for SIJD where the to is in supine and resistance is provided as the client actively abducts the hip
32
What is a positive active abduction test?
Reproduction of pain over the SIJ
33
What is the Fortin Finger Test?
A LPHC symptom reproduction test where you ask the to to point to their pain and they point over the PSIS for SIJD
34
What is a positive Fortin finger test?
If the pt points to the PSIS
35
What are the 6 clustered SIJ tests?
SIJ distraction provocation
Thigh thrust
Gaenslen
SIJ compression
Sacral thrust
Supine to sit test
36
How do we perform the thigh thrust test?
Similar to the POSH test, but more direct with the knee up towards the ceiling
37
How do we perform the sacral thrust test?
Pone, apply PA pressure on the sacrum to see if it creates a reproduction of pain
38
How many positive tests in the SIJ cluster gives up reasonable assurance that something SI is going on?
3 or more
39
What are the neurological provocation tests?
SLR
Prone knee bend
Slump test
Brudsinski-Kernig sign
Bike test
Bowstring test
40
How do we perform a SLR test with a sciatic nerve bias?
Hip flex
Hip abd
Hip IR
Knee ext
Ankle DF
41
At 0-35 deg SLR with sciatic nerve bias, what occurs?
Sciatic nerve slack is taken up
42
At 35-70 deg SLR with sciatic nerve bias, what occurs?
Nerve root tension
43
At >70 deg SLR with sciatic nerve bias, what occurs?
Joint pain
44
What does it mean when we do the SLR test on one side and it creates pain on the other side?
It is positive for neural tension on the other side
45
How do we perform a SLR test with a tibial nerve bias?
Hip flex
Hip add
Hip IR
Knee ext
Ankle DF
Foot eversion
46
How do we perform a SLR test with a sural nerve bias?
Hip flex
Hip add
Hip IR
Knee ext
Ankle DF
Foot inversion
47
How do we perform a SLR test with a common peroneal nerve bias?
Hip flex
Hip add
Hip IR
Knee ext
Ankle PF
Foot inversion
48
How do we perform the prone knee bend test with femoral nerve bias?
Hip in neutral
Knee flex
49
How do we perform the prone knee bend test with lateral femoral cutaneous nerve bias?
Hip ext
Hip add
Knee flex
50
How do we perform the prone knee bend test with saphenous nerve bias?
Hip ext
Hip abd
Hip ER
Knee ext
Ankle DF
Foot eversion
51
How do we perform the slump test?
Trunk flex
Cervical flex
Knee ext
Ankle DF
Release cervical and knee components
CAN DO FLOSSING HERE
52
What does the slump test do?
Creates neural tension from head to toe
53
What is the Brudzkinski-Kernig sign?
A way to assess for meningeal irritation, dural irritation, nerve root involvement
Have the pt in supine with their hands behind their head and have them flex their neck and actively perform a SLR
54
What will happen in a Brudsinski-Kernig sign if the SLR with neck flexion is symptomatic?
Flex the knees to reduce symptoms
55
What is the bike test?
An assessment for neurogenic vs intermittent vascular claudication
56
How do we perform the bike test?
Have the pt bike until their symptoms come on, then have the slump to try to relieve their symptoms
57
What is a positive bike test?
Onset of LE symptoms that reduce when the pt slumps, indicating neurogenic claudication
58
If a pt has intermittent vascular claudication, will slumping with the bike test relieve symptoms?
Nope
59
If a pt has neurogenic claudication, will slumping with the bike test relieve symptoms?
Yup
60
What is the Bowstring test?
An assessment for sciatic nerve tension where the pt is in supine and performs a SLR to reproduction of pain, then flex the knee for reduction of pain, then palpation of the popliteal fossa that increases symptoms
61
What is a positive Bowstring test?
Reduction of radicular symptoms until palpation of popliteal area
62
T/f: when the spinal stability tests are compared to radiologic dx, passive lumbar extension was the most accurate for dx of spinal instability
True
63
What are the clinical prediction rules for stabilization of LBP?
<40 yo
Avg SLR >91 deg
(+) prone instability test
(+) hypermobility with spring testing
64
If more than 3 clinical prediction rules for stabilization for LBP are positive, what does this mean?
That the probability of experiencing improvement from stabilization increased from 33% to 67%
65
What are the spinal stability tests?
Prone instability test
Pheasant test
Active SLR test
66
What is the prone instability test?
An assessment of segmental stability with the pt leaning over the table w and wo leg support while applying anterior glide to the segment
67
What is a positive prone instability test?
Reproduction of pain that reduces when the legs are lifted
68
Why does lifting the leg with a prone instability test reduce symptoms?
Bc it turns on the stabilization system and tightens up the spine
69
What is the phaesant test?
A test for spinal segmental instability where the pt is prone and the knee is passively flexed while pressure is applied to the tested segments to create more instability
70
What is a positive phaesant test?
Reproduction of symptoms
71
What is the active ASLR test?
A test for pelvic instability where the pt is supine and performs an active SLR and an onset of symptoms is noted, so a medically directed force is applied through the ilia and symptoms reduce
72
What is a positive ASLR test?
Pain with ASLR that is reduced with medically directed force at the ilia
73
T/f: there is no evidence that any one of the four SIJ specific tests were able to differentiate bw subjects with positional faults
True
74
Did the use of 2 or more structural tests improve their diagnostic usefulness?
Nope
75
What is the supine to long sit test?
An assessment for fxnal and structural LLD where leg length is assessed in supine and long sitting
76
What is a positive supine to sit test?
Change in length reveals fxnal LLD of at least 2.54 cm change
77
With a R upslip, the R leg will be ____ in supine and ____ in sitting
Shorter, shorter
78
With a R down slip, the R leg will be _____ in supine and _____ in long sitting
Longer, longer
79
With a R anterior rotation, the R leg will be _____ in supine and _____ in long sitting
Longer or equal, shorter
80
With a R posterior rotation, the R leg will be _____ in supine and _____ in long sitting
Shorter or equal, longer
81
With a L upslip, the L leg will be _____ in supine and ______ in long sitting
Shorter, shorter
82
With a L downslip, the L leg will be _____ in supine and ______ in long sitting
Longer, longer
83
With a L anterior rotation, the L leg will be _______ in supine and ______ in long sitting
Longer or equal, shorter
84
With a L posterior rotation, the L leg will be _____ in supine and ______ in long sitting
Shorter or equal, longer
85
With a R LLD the R leg will be _____ in supine and _____ in long sitting
Shorter, shorter
86
With a L LLLD, the L leg will be ____ in supine and _____ in long sitting
Shorter, shorter
87
What are the 5 categories of the Waddell non organic sign?
Tenderness
Simulation
Distraction
Regional
Overreaction
88
What are the signs in the tenderness category of the Waddell non organic sign?
Superficial (tender to light touch in a broach area)
Non-anatomical (deep tenderness over a broad area)
89
What are the signs in the simulation category of the Waddell non organic sign?
Axial loading (pressure on the head in standing causes LB pain)
Rotation (moving the hips and pelvis together to stop counter rotation of the lumbar spine)
90
What is involved in the distraction category of the Waddell non organic sign?
SLR in sitting and supine
91
What is a positive distraction category in the Waddell non organic sign?
30deg dif in SLR in sitting vs supine
92
What are the signs in the regional category of the Waddell non organic sign?
Weakness (cogwheel, widespread, non myotomal)
Sensory (stocking, non dermatomal)
93
How many categories of the Waddell non organic sign have to be positive to have a positive sign?
3/5
94
T/f: the Waddell non organic signs ID non organic signs but not the motive
True
95
What is a positive Waddell simulation?
Reproduction of LBP with axial lad applied to the head or with rotation of the shoulders and pelvis together
96
What is a positive Waddell sign for distraction?
A difference of more than 30 deg bw SLR in supine and sitting
97
What do we palpate for?
Condition, position, mobility
Symptom reproduction
Reactivity level
Tissue, gesture, tension, tone
Presence of trigger or tender points
