LQ - Orthopaedic tests

Question 1

Supported forward bend

Answer 1

Differentiation test (Lx vs SI)

1. Stand behind patient
2. Hands on hip bones (ASIS)
3. Stand side on to patient with leg against sacrum (stabilise pelvis)
4. Patient bend forward

Positive test
- Pain = lumbar spine
- No pain = SI/pelvis

Don’t use for disc or nerve problem!

Question 2

Standing kemps

Answer 2

Disc / Lateral foraminal stenosis / SI

Can be done passive or active
1. Hand behind on back of thigh
2. Run hand down back of the leg into extension
3. Passive = goose neck & opposite hand on PSIS, guide the patient & apply a slight pressure

Positive test
- Localised pain = SI/facet
- Pain on opposite side = muscle stretch
- Radicular pain = nerve root impingement

Question 3

Sitting kemps

Answer 3

Disc / Lateral foraminal stenosis / SI

1. Goose neck over shoulders (testing L side = elbow of L shoulder)
2. Stabilise PSIS (eliminating SI joint movement to remove pelvis)
3. Extension & lateral flexion

Positive test
- Localised pain = SI/facet
- Pain on opposite side = muscle stretch
- Radicular pain down leg = nerve root impingement

Question 4

SLR - straight leg raise

Answer 4

Root / SI / Lx / muscle

1. Patient supine with legs straight
2. Support under ankle & under knee
3. Raise leg as far as possible starting from 0 degrees

Positive test
- Pain 0-35 degrees = extradural (outside the dura, piriformus/SI joint)
- Pain 35-70 degrees = disc problem (nerve root is maximally stretched over the disc)
- Pain 70+ degrees = lumbar problem (nerve root is fully stretched)

Most patients cant reach 70 degrees due to tight hamstrings

Always do if patient has radicular pain

Question 5

Farfan torsion test

Answer 5

Facet joints

1. Patient prone
2. Stabilise around T12 (leave lumbar spine exposed)
3. Slide hand round to ASIS and lift (rocking motion)

Positive test
Pain = facet irritation (pain on either side)

Question 6

Passive lumbar extension test

Answer 6

Lumbar instability / facet irritation

1. Patient prone
2. Ski stance
3. Hold under ankles & lift legs 30 degrees (lumbar spine in extension)
4. Gently pull (create tension to distract the joints = instability)

Positive test
Facet irritation or lumbar instability