Lumbar Flashcards
What does straight let raise test for
Increased pressure on nerve root
Piriformis entrapment
SI/lumbar sprain/strain
Technique for SLR
Supine
Flex leg from hip, keep leg fully extended
Raise leg until pain/discomfort, slightly lower leg out of this range
Dorsiflex foot- Bragards (inc sciatic nerve root tension)
Flex big toe- Cicards
Bonnets sign SLR
Perform usual SLR
Lower leg to point just before exacerbation
IR + abd Pts hip
Interpretation- +Ve radicular P= sciatica radiculopathy, nerve root compression
Breig and troup SLR
Same as Bonnets but ask Pt to flex neck
Interpretation- radicular leg P= sciatica radiculopathy, nerve root compression (neck flexion inc nerve root tension
+ve SLR
Radicular leg P (shooting)
Localised low back pain
0-35 deg- hip Jt
35-70- disc/nerve root
>70- SI/lumbar Jt P
SLR criteria for sciatica secondary to disc herniation
Leg P > back P
Dermatomal parasthesia
SLR limited to 50% of normal
2/4 neuro signs- atrophy, motor weakness, red sensation, red deep tendon reflex
SLR clinical notes
1st ask Pt to perform actively (measures functional capability)
Also measures hamstring contracture
What does femoral nerve traction test
Femoral N or root compression (L2-4 radiculopathy)
Lateral disc herniation
Femoral N traction technique
Pt lay on unaffected side
Flex lower leg
Neutral spine
Head slightly flexed
Extend top leg to 15 deg, flex knee (further stretch fem nerve)
+ve Femoral N traction test
Radiation down anterior thigh
*P may be caused from tight IT band= -ve)
Details about dermatomes for Femoral N traction test
P in groin + hip that radiates along ant/med thigh= L3 nerve root problem
P extending to mid tibia indicates L4 nerve root problem
Antalgia sign procedure
Standing Pt present with antalgic (P avoidance) posture
SB of Lsp
Antalgia sign interpretation
+Ve SB–> facet irritation or in presence of radicular symptoms:
1. Pt leans away from affected side –> disc herniation lateral to nerve root
2. Pt leans towards affected side –> disc herniation medial to nerve root
Antalgia sign clinical notes
Central disc herniation, Pts often present flexed forward without SB
Belt test/ Adams test procedure
Standing Pt forward flexes to touch toes with knees straight and returns to standing
Examiner then stabilises Pts pelvis bilaterally over ASIS w hands and Pts sacrum w examiners lateral thigh
Pt repeats touching toes motion
Belt test interpretation
P with both supported and unsupported= Lsp patho
No P with support= SIJ patho
Elys heel to buttock test procedure
Pt prone with legs relaxed
Examiner passively flexes knee so heel touches contralateral buttock
Examiner then extends hip by elevating knee
Elys heel to buttock test interpretation
P with knee flexion- femoral nerve root comp, quad muscle contracture
P with hip extension- femoral nerve root compression, iliopsoas muscle strain or inflammation
Elys heel to buttock test clinical notes
Possible with L1-3 disc herniation to have radicular symptoms raidate to ant thigh and groin
Goldthwaits test procedure
Pt supine
Examiner slowly raises Pts affected leg with one hand while palpating motion at Lsp with other hand
Repeat on other side
Goldthwaits test interpretation
P before Lsp motion is felt= SIJ
P beginnign Lsp motion= lumbosacral patho
Goldthwaits clinical notes
SIJ involvement should be suspected if unaffected leg can be elevated higher than affected leg
Consider placing one finger to palpate SI (just medial to PSIS) and other hand to palp Lsp to better assess motion
Slump procedure
Seated
Slump forward
Examiner extends one knee and may apply gentle pressure to inc spinal flexion
Slump interpretation
Reproduction of symptoms–> leg P= nerve root tension (shooting or electrical), radiculopathy, disc herniation, osteophyte
Local lumbosacral P= strain or sprain
