Lumbar

Question 1

What does straight let raise test for

Answer 1

Increased pressure on nerve root
Piriformis entrapment
SI/lumbar sprain/strain

Question 2

Technique for SLR

Answer 2

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

Question 3

Bonnets sign SLR

Answer 3

Perform usual SLR
Lower leg to point just before exacerbation
IR + abd Pts hip

Interpretation- +Ve radicular P= sciatica radiculopathy, nerve root compression

Question 4

Breig and troup SLR

Answer 4

Same as Bonnets but ask Pt to flex neck

Interpretation- radicular leg P= sciatica radiculopathy, nerve root compression (neck flexion inc nerve root tension

Question 5

+ve SLR

Answer 5

Radicular leg P (shooting)
Localised low back pain
0-35 deg- hip Jt
35-70- disc/nerve root
>70- SI/lumbar Jt P

Question 6

SLR criteria for sciatica secondary to disc herniation

Answer 6

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

Question 7

SLR clinical notes

Answer 7

1st ask Pt to perform actively (measures functional capability)
Also measures hamstring contracture

Question 8

What does femoral nerve traction test

Answer 8

Femoral N or root compression (L2-4 radiculopathy)
Lateral disc herniation

Question 9

Femoral N traction technique

Answer 9

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)

Question 10

+ve Femoral N traction test

Answer 10

Radiation down anterior thigh

*P may be caused from tight IT band= -ve)

Question 11

Details about dermatomes for Femoral N traction test

Answer 11

P in groin + hip that radiates along ant/med thigh= L3 nerve root problem

P extending to mid tibia indicates L4 nerve root problem

Question 12

Antalgia sign procedure

Answer 12

Standing Pt present with antalgic (P avoidance) posture
SB of Lsp

Question 13

Antalgia sign interpretation

Answer 13

+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

Question 14

Antalgia sign clinical notes

Answer 14

Central disc herniation, Pts often present flexed forward without SB

Question 15

Belt test/ Adams test procedure

Answer 15

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

Question 16

Belt test interpretation

Answer 16

P with both supported and unsupported= Lsp patho
No P with support= SIJ patho

Question 17

Elys heel to buttock test procedure

Answer 17

Pt prone with legs relaxed
Examiner passively flexes knee so heel touches contralateral buttock
Examiner then extends hip by elevating knee

Question 18

Elys heel to buttock test interpretation

Answer 18

P with knee flexion- femoral nerve root comp, quad muscle contracture
P with hip extension- femoral nerve root compression, iliopsoas muscle strain or inflammation

Question 19

Elys heel to buttock test clinical notes

Answer 19

Possible with L1-3 disc herniation to have radicular symptoms raidate to ant thigh and groin

Question 20

Goldthwaits test procedure

Answer 20

Pt supine
Examiner slowly raises Pts affected leg with one hand while palpating motion at Lsp with other hand
Repeat on other side

Question 21

Goldthwaits test interpretation

Answer 21

P before Lsp motion is felt= SIJ
P beginnign Lsp motion= lumbosacral patho

Question 22

Goldthwaits clinical notes

Answer 22

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

Question 23

Slump procedure

Answer 23

Seated
Slump forward
Examiner extends one knee and may apply gentle pressure to inc spinal flexion

Question 24

Slump interpretation

Answer 24

Reproduction of symptoms–> leg P= nerve root tension (shooting or electrical), radiculopathy, disc herniation, osteophyte
Local lumbosacral P= strain or sprain